Provider Demographics
NPI:1881737096
Name:CLAGETT, DANIEL RYAN (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:RYAN
Last Name:CLAGETT
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 WESTPORT RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2920
Mailing Address - Country:US
Mailing Address - Phone:270-982-7377
Mailing Address - Fax:270-982-4415
Practice Address - Street 1:551 WESTPORT RD
Practice Address - Street 2:SUITE B
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2920
Practice Address - Country:US
Practice Address - Phone:270-982-7377
Practice Address - Fax:270-982-4415
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY79441223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics