Provider Demographics
NPI:1265589980
Name:SULEK, CLAYTON (DD DENTURIST)
Entity type:Individual
Prefix:
First Name:CLAYTON
Middle Name:
Last Name:SULEK
Suffix:
Gender:M
Credentials:DD DENTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 KING ST.
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229
Mailing Address - Country:US
Mailing Address - Phone:360-647-0395
Mailing Address - Fax:360-594-4387
Practice Address - Street 1:1329 KING ST.
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229
Practice Address - Country:US
Practice Address - Phone:360-647-0395
Practice Address - Fax:360-594-4387
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA395122400000X
WA00000395122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA20-1780598OtherTAX IDENTIFICATION NUMBER
WA5047287Medicaid