Provider Demographics
NPI:1992799613
Name:CLAYMAN, LEWIS (DMD, MD)
Entity type:Individual
Prefix:MR
First Name:LEWIS
Middle Name:
Last Name:CLAYMAN
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 APPIAN WAY
Mailing Address - Street 2:STE 201
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564
Mailing Address - Country:US
Mailing Address - Phone:510-724-3922
Mailing Address - Fax:510-724-1037
Practice Address - Street 1:2150 APPIAN WAY
Practice Address - Street 2:STE 201
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564
Practice Address - Country:US
Practice Address - Phone:510-724-3922
Practice Address - Fax:510-724-3922
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0498551223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI103322652Medicaid
MIOM54450Medicare ID - Type Unspecified