Individual
DR. RICHARD J CLAYDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
107 S PROSPECT, BLOOMINGTON, IL 61704
(309) 662-9318
(309) 662-8331
Mailing address
107 S PROSPECT, BLOOMINGTON, IL 61704
(309) 662-9318
(309) 662-8331
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
755134
UNITED CONCORDIA
—
01
—
80115928
BLUE CROSS BLUE SHIELD
—
Enumeration date
12/12/2006
Last updated
07/08/2007
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