Provider Demographics
NPI:1104991389
Name:FLORIANI, CLAYTON CANTRELL (DDS)
Entity type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:CANTRELL
Last Name:FLORIANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6264 POPLAR AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119
Mailing Address - Country:US
Mailing Address - Phone:901-767-2152
Mailing Address - Fax:901-767-2155
Practice Address - Street 1:6264 POPLAR AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119
Practice Address - Country:US
Practice Address - Phone:901-767-2152
Practice Address - Fax:901-767-2155
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN77561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice