Ryan Wesley Clayton, BS, DMD
Individual provider Active NPI General Practice Dentistry · Polo, IL
NPI 1194254979 · NPPES record last updated Jun 6, 2017
Key facts
- NPI
- 1194254979
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 019031180 (IL)
- Practice address
- 1107 S Division Ave
Polo, IL 61064-1875 - Phone
- (815) 946-3848
- NPI assigned
- Jun 6, 2017
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019031180 | IL | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019031180 | IL | Yes |
Addresses
Primary practice location
1107 S Division Ave
Polo, IL 61064-1875
Mailing address
11276 W Judson Rd
Polo, IL 61064-9042
Phone (815) 677-0462
Other providers in Polo, IL
- Karla J Byrd
- Thomas Albert Cline
- Debra C Drengenberg
- Angelia Faller
- Felker Pharmacy Inc
- Theresa Lynn Fitzgerald
All providers in Polo, IL · General Practice Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 6, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.