Organization
CLAYTON A GAUTREAUX D.D.S
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GENA D PASSONS R.D.A (DENTAL ASSISTANT)
(903) 887-4405
Entity
Organization
Contact information
Practice address
302 N 3RD ST, MABANK, TX 75147-8611
(903) 887-4405
Mailing address
302 N 3RD ST, MABANK, TX 75147-8611
(903) 887-4405
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12190
TX
1223G0001X
General Practice Dentistry
23280
TX
1223P0221X
Pediatric Dentistry
14921
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12190
—
TX
05
—
14921
—
TX
05
—
23280
—
TX
Enumeration date
12/10/2009
Last updated
12/10/2009
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