Provider Demographics
NPI:1891997128
Name:GAUTREAUX, CLAYTON A (DDS)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:A
Last Name:GAUTREAUX
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 1:302 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MABANK
Mailing Address - State:TX
Mailing Address - Zip Code:75147-8611
Mailing Address - Country:US
Mailing Address - Phone:903-887-4405
Mailing Address - Fax:903-887-5040
Practice Address - Street 1:302 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MABANK
Practice Address - State:TX
Practice Address - Zip Code:75147-8611
Practice Address - Country:US
Practice Address - Phone:903-887-4405
Practice Address - Fax:903-887-5040
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice