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Individual

CLAYTON BOOTH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
59 DG-AF POSTGRADUATE DENTAL SCHOOL, 2133 PEPPERRELL ST, BLDG 3352, JBSA-LACKLAND, TX 78236-5313
(210) 292-6258
Mailing address
116 VALONA DR, CIBOLO, TX 78108-4233
(210) 916-2330

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12879487-9922
UT
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
12879487-9922
UT
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
06/10/2022
Last updated
08/22/2023
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