Provider Demographics
NPI:1831225358
Name:LATHROP, CLYDE WILSON (DDS)
Entity type:Individual
Prefix:
First Name:CLYDE
Middle Name:WILSON
Last Name:LATHROP
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6945 E SAHUARO DR
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6722
Mailing Address - Country:US
Mailing Address - Phone:602-405-6700
Mailing Address - Fax:602-485-9125
Practice Address - Street 1:6945 E SAHUARO DR
Practice Address - Street 2:SUITE A-2
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6722
Practice Address - Country:US
Practice Address - Phone:602-405-6700
Practice Address - Fax:602-485-9125
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice