MEDICARE: DR. CLAYTON HUGHES MCENTIRE D.M.D., M.S.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	19531	FL

General Provider Information

NPI Number	:	1629491931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLAYTON HUGHES MCENTIRE D.M.D., M.S.D.

Provider Business Mailing Address
First Line	:	3516 W BAY TO BAY BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-7045
Country	:	US
Telephone Number	:	813-250-0313
Fax Number	:	813-250-0313

Provider Business Practice Location Address
First Line	:	3516 W BAY TO BAY BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-7045
Country	:	US
Telephone Number	:	813-250-0313
Fax Number	:	813-250-0313

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2014
Last Update Date	:	01/23/2014

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