Provider Demographics
NPI:1184353526
Name:CLANTON, WENDI RENEE (DMD)
Entity type:Individual
Prefix:DR
First Name:WENDI
Middle Name:RENEE
Last Name:CLANTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 REECE DR
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-1390
Mailing Address - Country:US
Mailing Address - Phone:706-424-3941
Mailing Address - Fax:
Practice Address - Street 1:1363 OLD PENDERGRASS RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-2790
Practice Address - Country:US
Practice Address - Phone:706-387-0305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN122689122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist