Healthcare Provider Details

I. General information

NPI: 1275607053
Provider Name (Legal Business Name): DAVID THOMAS ST CLAIR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NEW HOPE ROAD MEDICAL ARTS CLINIC SUITE 205
PRINCETON WV
24740
US

IV. Provider business mailing address

100 NEW HOPE ROAD MEDICAL ARTS CLINIC SUITE 205
PRINCETON WV
24740
US

V. Phone/Fax

Practice location:
  • Phone: 304-487-5437
  • Fax:
Mailing address:
  • Phone: 304-487-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2131 SPECIALTY 17
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401008536
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN10837
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: