Provider Demographics
NPI:1962612580
Name:CLAYTON R. DAVIS, D.M.D., P.C.
Entity type:Organization
Organization Name:CLAYTON R. DAVIS, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-476-9747
Mailing Address - Street 1:3473 SATELLITE BLVD.
Mailing Address - Street 2:SUITE #102
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8691
Mailing Address - Country:US
Mailing Address - Phone:770-476-9747
Mailing Address - Fax:770-622-4854
Practice Address - Street 1:3473 SATELLITE BLVD
Practice Address - Street 2:SUITE #102
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8690
Practice Address - Country:US
Practice Address - Phone:770-476-9747
Practice Address - Fax:770-622-4854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN009153122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty