Provider Demographics
NPI:1871652032
Name:WORTON, CLINTON THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:THOMAS
Last Name:WORTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:620 KIRKLAND WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6021
Mailing Address - Country:US
Mailing Address - Phone:425-822-2500
Mailing Address - Fax:425-822-2599
Practice Address - Street 1:620 KIRKLAND WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6021
Practice Address - Country:US
Practice Address - Phone:425-822-2500
Practice Address - Fax:425-822-2599
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 87141223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry