Provider Demographics
NPI:1992357156
Name:CLAXTON FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:CLAXTON FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZACKARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BENTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-557-6307
Mailing Address - Street 1:209 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:CLAXTON
Mailing Address - State:GA
Mailing Address - Zip Code:30417-1911
Mailing Address - Country:US
Mailing Address - Phone:912-732-1011
Mailing Address - Fax:
Practice Address - Street 1:209 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:CLAXTON
Practice Address - State:GA
Practice Address - Zip Code:30417-1911
Practice Address - Country:US
Practice Address - Phone:912-732-1011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty