Healthcare Provider Details

I. General information

NPI: 1932210531
Provider Name (Legal Business Name): DAVID WILLIAM CLANTON D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 BROOKWOOD MEDICAL CTR DR SUITE 24
BIRMINGHAM AL
35209-6874
US

IV. Provider business mailing address

2045 BROOKWOOD MEDICAL CTR DR SUITE 24
BIRMINGHAM AL
35209-6874
US

V. Phone/Fax

Practice location:
  • Phone: 205-870-8833
  • Fax: 205-870-0120
Mailing address:
  • Phone: 205-870-8833
  • Fax: 205-870-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number3661
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number9500
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: