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General NPI Number Information
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NPI Number | 1205706686
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Entity Type | Individual
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Provider Name | MACKENZIE CLAYTON DDS
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Gender | Female
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Dates
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Enumeration Date | 11/10/2025
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 2700 S 1ST ST
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City | AUSTIN
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State | TX
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Zip | 78704-5421
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Country | US
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Telephone | 737-510-4556
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Fax |
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Provider Business Mailing Address
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Address Line | 3965 LACLEDE AVE APT 203
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City | SAINT LOUIS
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State | MO
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Zip | 63108-3283
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Country | US
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Telephone |
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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 | 42017
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License Number State | TX
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