Provider Demographics
NPI:1275040628
Name:CLAY, GEORGE WILLIS III (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WILLIS
Last Name:CLAY
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2388 SPRINGS RD NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-3066
Mailing Address - Country:US
Mailing Address - Phone:828-256-7958
Mailing Address - Fax:828-256-8499
Practice Address - Street 1:2388 SPRINGS RD NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3066
Practice Address - Country:US
Practice Address - Phone:828-256-7958
Practice Address - Fax:828-256-8499
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC40431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice