Healthcare Provider Details

I. General information

NPI: 1649332180
Provider Name (Legal Business Name): CLAYTON DENTAL OFFICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 GRAVES ST
CLAYTON NY
13624-1503
US

IV. Provider business mailing address

775 GRAVES ST PO BOX 405
CLAYTON NY
13624-1503
US

V. Phone/Fax

Practice location:
  • Phone: 315-686-5142
  • Fax: 315-686-2310
Mailing address:
  • Phone: 315-686-5142
  • Fax: 315-686-2310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number046003
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number046003
License Number StateNY

VIII. Authorized Official

Name: SCOTT A LACLAIR
Title or Position: OWNER
Credential: DDS
Phone: 315-686-5142