Healthcare Provider Details

I. General information

NPI: 1427933837
Provider Name (Legal Business Name): MCCLAY IRENE CARSON RDH, CDHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 N WESTWOOD BLVD
POPLAR BLUFF MO
63901-3315
US

IV. Provider business mailing address

110 S 2ND ST
ELLINGTON MO
63638-9400
US

V. Phone/Fax

Practice location:
  • Phone: 573-778-3042
  • Fax: 573-778-9432
Mailing address:
  • Phone: 573-663-2313
  • Fax: 573-663-2441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2020016624
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: