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General NPI Number Information
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NPI Number | 1184353526
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Entity Type | Individual
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Provider Name | WENDI RENEE CLANTON DMD
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Gender | Female
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Dates
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Enumeration Date | 06/09/2022
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 1363 OLD PENDERGRASS RD
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City | JEFFERSON
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State | GA
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Zip | 30549-2790
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Country | US
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Telephone | 706-387-0305
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Fax |
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Provider Business Mailing Address
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Address Line | 462 REECE DR
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City | HOSCHTON
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State | GA
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Zip | 30548-1390
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Country | US
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Telephone | 706-424-3941
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN122689
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License Number State | GA
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