Provider Demographics
NPI:1528283827
Name:CLAYTON, NEILL PYBURN (DDS)
Entity type:Individual
Prefix:DR
First Name:NEILL
Middle Name:PYBURN
Last Name:CLAYTON
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 1:1112 N FLOYD RD
Mailing Address - Street 2:STE 5
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-4243
Mailing Address - Country:US
Mailing Address - Phone:972-231-4876
Mailing Address - Fax:972-234-4145
Practice Address - Street 1:1112 N FLOYD RD
Practice Address - Street 2:STE 5
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4243
Practice Address - Country:US
Practice Address - Phone:972-231-4876
Practice Address - Fax:972-234-4145
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8165OtherLICENCE