Provider Demographics
NPI:1114590114
Name:YODER, CLAYTON WICK (DDS)
Entity type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:WICK
Last Name:YODER
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5002 RIVERSIDE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77345-1281
Mailing Address - Country:US
Mailing Address - Phone:832-233-0719
Mailing Address - Fax:
Practice Address - Street 1:9205 EAGLE DR STE 100
Practice Address - Street 2:
Practice Address - City:MONT BELVIEU
Practice Address - State:TX
Practice Address - Zip Code:77523-5620
Practice Address - Country:US
Practice Address - Phone:281-241-4249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX375741223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice