Provider Demographics
NPI:1457935116
Name:CLAYTON DENTISTRY
Entity Type:Organization
Organization Name:CLAYTON DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-728-0970
Mailing Address - Street 1:97 BOUNDRY LN
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2949
Mailing Address - Country:US
Mailing Address - Phone:724-728-0970
Mailing Address - Fax:
Practice Address - Street 1:97 BOUNDRY LN
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2949
Practice Address - Country:US
Practice Address - Phone:724-728-0970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty