Provider Demographics
NPI:1184950958
Name:CLAYTON, CHARLES GARY (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:GARY
Last Name:CLAYTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:C
Other - Middle Name:GARY
Other - Last Name:CLAYTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:POST OFFICE BOX 11298
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-0298
Mailing Address - Country:US
Mailing Address - Phone:757-624-1834
Mailing Address - Fax:
Practice Address - Street 1:327 WEST 21ST STREET
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-0298
Practice Address - Country:US
Practice Address - Phone:757-624-1834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010059631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice