Provider Demographics
NPI:1962711606
Name:OLDHAM, CODY CLAYTON (DDS)
Entity type:Individual
Prefix:DR
First Name:CODY
Middle Name:CLAYTON
Last Name:OLDHAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3408 N MIDKIFF RD STE 305
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-4836
Mailing Address - Country:US
Mailing Address - Phone:432-400-5005
Mailing Address - Fax:432-277-1765
Practice Address - Street 1:3408 N MIDKIFF RD STE 305
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-4836
Practice Address - Country:US
Practice Address - Phone:432-400-5005
Practice Address - Fax:432-277-1765
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX255691223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice