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General NPI Number Information
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NPI Number | 1962612580
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Entity Type | Organization
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Legal Business Name | CLAYTON R. DAVIS, D.M.D., P.C.
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3473 SATELLITE BLVD SUITE #102
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City | DULUTH
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State | GA
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Zip | 30096-8690
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Country | US
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Telephone | 770-476-9747
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Fax | 770-622-4854
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Provider Business Mailing Address
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Address Line | 3473 SATELLITE BLVD. SUITE #102
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City | DULUTH
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State | GA
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Zip | 30096-8691
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Country | US
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Telephone | 770-476-9747
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Fax | 770-622-4854
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CLAYTON R. DAVIS
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Credential | D.M.D.
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Telephone | 770-476-9747
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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 | DN009153
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License Number State | GA
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