Provider Demographics
NPI:1649332180
Name:CLAYTON DENTAL OFFICES, PLLC
Entity type:Organization
Organization Name:CLAYTON DENTAL OFFICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DELLA
Authorized Official - Middle Name:HATTIE
Authorized Official - Last Name:RAMSDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-686-5142
Mailing Address - Street 1:775 GRAVES ST
Mailing Address - Street 2:PO BOX 405
Mailing Address - City:CLAYTON
Mailing Address - State:NY
Mailing Address - Zip Code:13624-1503
Mailing Address - Country:US
Mailing Address - Phone:315-686-5142
Mailing Address - Fax:315-686-2310
Practice Address - Street 1:775 GRAVES ST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NY
Practice Address - Zip Code:13624-1503
Practice Address - Country:US
Practice Address - Phone:315-686-5142
Practice Address - Fax:315-686-2310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046003332B00000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02145935Medicaid
NY1952355208OtherINDIVIDUAL NPI #