Provider Demographics
NPI:1114763166
Name:SMITH, CLAYTON THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:THOMAS
Last Name:SMITH
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 1:14442 OAKGLEN DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-5028
Mailing Address - Country:US
Mailing Address - Phone:615-604-2621
Mailing Address - Fax:
Practice Address - Street 1:10427 ULMERTON RD STE B3
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3530
Practice Address - Country:US
Practice Address - Phone:727-535-9993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN293311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice