Provider Demographics
NPI:1669103636
Name:SPILMAN, CLAYTON ALAN (DMD)
Entity type:Individual
Prefix:
First Name:CLAYTON
Middle Name:ALAN
Last Name:SPILMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4899 5TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-7217
Mailing Address - Country:US
Mailing Address - Phone:727-321-1427
Mailing Address - Fax:
Practice Address - Street 1:4899 5TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-7217
Practice Address - Country:US
Practice Address - Phone:727-321-1427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26983122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist