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General NPI Number Information
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NPI Number | 1043760622
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Entity Type | Organization
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Legal Business Name | CLAY DENTAL
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Dates
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Enumeration Date | 10/07/2016
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Last Update Date | 10/07/2016
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Provider Practice Location Address
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Address Line | 7801 HIGHWAY 59 SUITE F
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City | FOLEY
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State | AL
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Zip | 36535
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Country | US
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Telephone | 251-943-5632
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Fax |
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Provider Business Mailing Address
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Address Line | 7801 HIGHWAY 59 SUITE F
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City | FOLEY
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State | AL
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Zip | 36535
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Country | US
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Telephone | 251-943-5632
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL BRADLEY CLAY
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Credential | DMD
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Telephone | 251-943-5632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6083C
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License Number State | AL
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