Provider Demographics
NPI:1942308721
Name:M. WADE CLAYTON, DDS, PA, INC.
Entity Type:Organization
Organization Name:M. WADE CLAYTON, DDS, PA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:M
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-388-9110
Mailing Address - Street 1:2705 APPLING ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38133-5003
Mailing Address - Country:US
Mailing Address - Phone:901-388-9110
Mailing Address - Fax:901-384-7662
Practice Address - Street 1:2705 APPLING ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-5003
Practice Address - Country:US
Practice Address - Phone:901-388-9110
Practice Address - Fax:901-384-7662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7135122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty