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NPI Code Detail

MEDICARE: M. WADE CLAYTON, DDS, PA, INC.

MEDICARE: M. WADE CLAYTON, DDS, PA, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist7135TN

General Provider Information

NPI Number : 1942308721
Entity Type Code : Organization
Provider Name (Legal Business Name) : M. WADE CLAYTON, DDS, PA, INC.
Provider Business Mailing Address
First Line : 2705 APPLING ROAD
Second Line : SUITE 101
City : MEMPHIS
State : TN
Zip : 38133-5003
Country : US
Telephone Number : 901-388-9110
Fax Number : 901-384-7662
Provider Business Practice Location Address
First Line : 2705 APPLING ROAD
Second Line : SUITE 101
City : MEMPHIS
State : TN
Zip : 38133-5003
Country : US
Telephone Number : 901-388-9110
Fax Number : 901-384-7662
Authorized Official
Title or Position : PRESIDENT
Name : DR. M WADE CLAYTON
Credential : DDS
Telephone Number : 901-388-9110
Provider Enumeration Date : 09/20/2006
Last Update Date : 08/22/2020

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