Provider Demographics
NPI:1821168287
Name:CLAYCOMB, DEBRA G (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:G
Last Name:CLAYCOMB
Suffix:
Gender:F
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:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-0425
Mailing Address - Country:US
Mailing Address - Phone:434-572-3205
Mailing Address - Fax:434-572-8566
Practice Address - Street 1:431 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-3241
Practice Address - Country:US
Practice Address - Phone:434-572-3205
Practice Address - Fax:434-572-8566
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010064421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice