Provider Demographics
NPI:1013911767
Name:CLAYTON, LINDALEE (DMD)
Entity Type:Individual
Prefix:
First Name:LINDALEE
Middle Name:
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1392 JORDAN ROAD STE A
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35811
Mailing Address - Country:US
Mailing Address - Phone:256-852-9110
Mailing Address - Fax:256-852-3443
Practice Address - Street 1:1392 JORDAN ROAD STE A
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35811
Practice Address - Country:US
Practice Address - Phone:256-852-9110
Practice Address - Fax:256-852-3443
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN169521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075847700Medicaid