Provider Demographics
NPI:1770552549
Name:CLAYTON, MARK C (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:C
Last Name:CLAYTON
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Gender:M
Credentials:DDS
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Mailing Address - Street 1:4540 E OGLETHORPE HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-1431
Mailing Address - Country:US
Mailing Address - Phone:912-369-3692
Mailing Address - Fax:912-369-3938
Practice Address - Street 1:4540 E OGLETHORPE HWY
Practice Address - Street 2:SUITE A
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-1431
Practice Address - Country:US
Practice Address - Phone:912-369-3692
Practice Address - Fax:912-369-3938
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2011-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0119781223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00933567AMedicaid
GA1352952OtherUNITED CONCORDIA