Provider Demographics
NPI:1447874292
Name:CLYDE, SHEQUORI K (DMD)
Entity type:Individual
Prefix:DR
First Name:SHEQUORI
Middle Name:K
Last Name:CLYDE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 RED LANE RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215-8245
Mailing Address - Country:US
Mailing Address - Phone:205-836-4044
Mailing Address - Fax:
Practice Address - Street 1:524 RED LANE RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35215-8245
Practice Address - Country:US
Practice Address - Phone:205-836-4044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-07
Last Update Date:2020-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL67671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice