Provider Demographics
NPI:1124332564
Name:CLAYTON, TYLER W (DMD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:W
Last Name:CLAYTON
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 1:3347 E MAYBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-8254
Mailing Address - Country:US
Mailing Address - Phone:610-389-6259
Mailing Address - Fax:
Practice Address - Street 1:12005 N TATUM BLVD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-1650
Practice Address - Country:US
Practice Address - Phone:302-971-0026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ80141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice