Provider Demographics
NPI:1801316997
Name:OLIVER, CLAYTON SHANE (DMD)
Entity type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:SHANE
Last Name:OLIVER
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 1:198 E PEACOCK ST
Mailing Address - Street 2:
Mailing Address - City:COCHRAN
Mailing Address - State:GA
Mailing Address - Zip Code:31014-7852
Mailing Address - Country:US
Mailing Address - Phone:478-230-1346
Mailing Address - Fax:
Practice Address - Street 1:421 PLAZA AVE
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6749
Practice Address - Country:US
Practice Address - Phone:478-374-4716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0154471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice