Healthcare Provider Details

I. General information

NPI: 1982765517
Provider Name (Legal Business Name): C JEFF CLAY, D.D.S. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 01/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

479 FLAT TOP RD
SHADY SPRING WV
25918
US

IV. Provider business mailing address

479 FLAT TOP RD
SHADY SPRING WV
25918-8614
US

V. Phone/Fax

Practice location:
  • Phone: 304-763-4665
  • Fax: 304-763-5172
Mailing address:
  • Phone: 304-763-4665
  • Fax: 304-763-5172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2683
License Number StateWV

VIII. Authorized Official

Name: DR. CARL JEFFREY CLAY
Title or Position: PRESIDENT
Credential: D. D.S.
Phone: 304-763-4665