Healthcare Provider Details

I. General information

NPI: 1659220846
Provider Name (Legal Business Name): SCOTT CLAYHOLD DMD PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2026
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22605 SE 56TH ST STE 110
ISSAQUAH WA
98029-5297
US

IV. Provider business mailing address

22605 SE 56TH ST STE 110
ISSAQUAH WA
98029-5297
US

V. Phone/Fax

Practice location:
  • Phone: 425-369-1533
  • Fax: 425-369-1533
Mailing address:
  • Phone: 425-369-1533
  • Fax: 425-369-1536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. SCOTT CLAYHOLD
Title or Position: PRESIDENT
Credential: DMD
Phone: 425-891-4243