Provider Demographics
NPI:1356736961
Name:CLAYTON PEDIATRIC DENTAL CENTER
Entity type:Organization
Organization Name:CLAYTON PEDIATRIC DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BURTON
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HORWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:919-553-3202
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27528-0159
Mailing Address - Country:US
Mailing Address - Phone:919-553-3202
Mailing Address - Fax:919-883-4540
Practice Address - Street 1:400 TEW CT
Practice Address - Street 2:SUITE 106
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-2279
Practice Address - Country:US
Practice Address - Phone:919-553-3202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8994149Medicaid