Provider Demographics
NPI: | 1164793543 |
---|---|
Name: | CLARK, HAYS AND ASSOCIATES, PLLC |
Entity Type: | Organization |
Organization Name: | CLARK, HAYS AND ASSOCIATES, PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OFFICE MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | BEBE |
Authorized Official - Middle Name: | G |
Authorized Official - Last Name: | JACKSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 910-863-2377 |
Mailing Address - Street 1: | 4558 CAPITAL BLVD |
Mailing Address - Street 2: | SUITE B |
Mailing Address - City: | RALEIGH |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 27604-4537 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 919-861-7814 |
Mailing Address - Fax: | 919-861-7819 |
Practice Address - Street 1: | 104 FOURTH ST |
Practice Address - Street 2: | |
Practice Address - City: | BLADENBORO |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28320-9407 |
Practice Address - Country: | US |
Practice Address - Phone: | 910-863-2377 |
Practice Address - Fax: | 910-863-2555 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-01-18 |
Last Update Date: | 2012-01-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 7917 | 122300000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 122300000X | Dental Providers | Dentist | Group - Single Specialty |