Provider Demographics
NPI:1851371025
Name:HARPER, CLAYTON SCOTT (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:SCOTT
Last Name:HARPER
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 28TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1263
Mailing Address - Country:US
Mailing Address - Phone:718-685-6144
Mailing Address - Fax:
Practice Address - Street 1:2625 28TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1263
Practice Address - Country:US
Practice Address - Phone:303-938-0130
Practice Address - Fax:303-245-0405
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-22
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP44870122300000X, 1223G0001X
TX20788122300000X, 204E00000X
CO97351223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1223S0112XMedicaid