Provider Demographics
NPI:1922674787
Name:MYERS, CLAYTON (DDS)
Entity Type:Individual
Prefix:MR
First Name:CLAYTON
Middle Name:
Last Name:MYERS
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 1:59 S IDLEWILD ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3926
Mailing Address - Country:US
Mailing Address - Phone:901-726-9525
Mailing Address - Fax:
Practice Address - Street 1:59 S IDLEWILD ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3926
Practice Address - Country:US
Practice Address - Phone:901-726-9525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN115781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice