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General NPI Number Information
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NPI Number | 1659980068
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Entity Type | Individual
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Provider Name | CRAIG DOUGLASS CLAYTON II DMD
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Gender | Male
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Dates
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Enumeration Date | 07/31/2020
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Last Update Date | 12/27/2022
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Provider Practice Location Address
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Address Line | 3809 E AMITY RD STE 150
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City | MERIDIAN
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State | ID
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Zip | 83642
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Country | US
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Telephone | 208-229-1500
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Fax | 208-370-5552
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Provider Business Mailing Address
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Address Line | 7166 E FAREWELL BEND CT
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City | BOISE
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State | ID
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Zip | 83716-8100
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Country | US
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Telephone | 949-554-3545
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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 | D5175
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License Number State | ID
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