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General NPI Number Information
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NPI Number | 1548523665
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Entity Type | Individual
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Provider Name | CLAYTON MACK HAMRICK D.M.D., M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2012
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 410 N PLANT AVE
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City | PLANT CITY
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State | FL
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Zip | 33563-7248
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Country | US
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Telephone | 813-755-9102
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Fax |
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Provider Business Mailing Address
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Address Line | 11517 PERFECT PL
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City | TAMPA
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State | FL
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Zip | 33626-3364
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Country | US
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Telephone | 919-622-0899
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN19786
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License Number State | FL
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