Provider Demographics
NPI:1871579557
Name:CLANTON, RAEFORD LEE (DMD)
Entity type:Individual
Prefix:DR
First Name:RAEFORD
Middle Name:LEE
Last Name:CLANTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S MARION ST
Mailing Address - Street 2:
Mailing Address - City:LATTA
Mailing Address - State:SC
Mailing Address - Zip Code:29565-1522
Mailing Address - Country:US
Mailing Address - Phone:843-752-7655
Mailing Address - Fax:843-752-4500
Practice Address - Street 1:203 S MARION ST
Practice Address - Street 2:
Practice Address - City:LATTA
Practice Address - State:SC
Practice Address - Zip Code:29565-1522
Practice Address - Country:US
Practice Address - Phone:843-752-7655
Practice Address - Fax:843-752-4500
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1920122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ1920-3Medicaid