Clayton A. Gautreaux, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12190 Issued in TX

Practice address

302 N 3Rd St
Mabank, TX 75147-8611

Phone

(903) 887-4405

Fax

(903) 887-5040

NPI assigned

May 31, 2007

Sex

Male

Sole proprietor

Yes

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Clayton a Gautreaux D.D.S

  • General Practice Dentistry
  • Mabank, TX
  • NPI 1043549603

  General Practice

  NPD (past)
• Mabank Family Dentistry PLLC

  • General Practice Dentistry
  • Mabank, TX
  • NPI 1033772447

  General Practice

  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1891997128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 N 3RD ST",
            "city": "MABANK",
            "state": "TX",
            "postal_code": "751478611",
            "telephone_number": "903-887-4405",
            "fax_number": "903-887-5040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 N 3RD ST",
            "city": "MABANK",
            "state": "TX",
            "postal_code": "751478611",
            "telephone_number": "903-887-4405",
            "fax_number": "903-887-5040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAUTREAUX",
        "first_name": "CLAYTON",
        "middle_name": "A.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "12190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katie Farmer
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• Jeffrey Bryant Gaddis, D.C.
• Eric Gassman
• Timothy H Gilliam, LPC, LMFT
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• Cheryl Lynne Gordon, CPM, LM
• Samantha Goss, M.S, LCDC, LPC-I
• Priscilla Marie Gutierrez, LPC-ASSOCIATE

• All providers in Mabank, TX
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.