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General NPI Number Information
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NPI Number | 1982765517
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Entity Type | Organization
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Legal Business Name | C JEFF CLAY, D.D.S. INC.
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 01/26/2009
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Provider Practice Location Address
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Address Line | 479 FLAT TOP RD
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City | SHADY SPRING
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State | WV
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Zip | 25918
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Country | US
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Telephone | 304-763-4665
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Fax | 304-763-5172
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Provider Business Mailing Address
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Address Line | 479 FLAT TOP RD
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City | SHADY SPRING
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State | WV
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Zip | 25918-8614
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Country | US
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Telephone | 304-763-4665
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Fax | 304-763-5172
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CARL JEFFREY CLAY
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Credential | D. D.S.
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Telephone | 304-763-4665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2683
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License Number State | WV
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