Provider Demographics
NPI:1760739288
Name:CRAIG, CLAYTON THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:THOMAS
Last Name:CRAIG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 W 52ND ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-2810
Mailing Address - Country:US
Mailing Address - Phone:765-335-6694
Mailing Address - Fax:
Practice Address - Street 1:3750 GUION RD STE 280
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-1696
Practice Address - Country:US
Practice Address - Phone:765-336-6694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
IN12011846A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies