Healthcare Provider Details

I. General information

NPI: 1265589980
Provider Name (Legal Business Name): CLAYTON SULEK D.D. DENTURIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 KING ST.
BELLINGHAM WA
98229
US

IV. Provider business mailing address

1329 KING ST.
BELLINGHAM WA
98229
US

V. Phone/Fax

Practice location:
  • Phone: 360-647-0395
  • Fax: 360-594-4387
Mailing address:
  • Phone: 360-647-0395
  • Fax: 360-594-4387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122400000X
TaxonomyDenturist
License Number395
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number00000395
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: