1275704561 NPI number — MICHAEL J CLAYMORE DDS

Table of content: (NPI 1275704561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275704561 NPI number — MICHAEL J CLAYMORE DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL J CLAYMORE DDS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275704561
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 609
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PINEHURST
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83850-0609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-682-4540
Provider Business Mailing Address Fax Number:
208-682-2339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 N DIVISION STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINEHURST
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83850-0609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-682-4540
Provider Business Practice Location Address Fax Number:
208-682-2339
Provider Enumeration Date:
03/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CLAYMORE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
208-682-4540

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  D1817 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CS3387 . This is a "CONTROLLED SUBSTANCE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: D1817 . This is a "IDAHO DENTIST NUMBER" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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