Provider Demographics
NPI:1538189683
Name:WHEADON, SCOTT CLAYTON (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:CLAYTON
Last Name:WHEADON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 939
Mailing Address - Street 2:MACT HEALTH BOARD INC
Mailing Address - City:ANGELS CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95222
Mailing Address - Country:US
Mailing Address - Phone:209-754-6262
Mailing Address - Fax:209-736-1814
Practice Address - Street 1:13975 MONO WAY SUITE I
Practice Address - Street 2:MACT INDIAN DENTAL CLINIC
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-2824
Practice Address - Country:US
Practice Address - Phone:209-533-9603
Practice Address - Fax:209-533-9604
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA344401223D0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223D0001XDental ProvidersDentistDental Public Health