Provider Demographics
NPI:1477650034
Name:CLAY, ROGER DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:DEAN
Last Name:CLAY
Suffix:
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 1:1515 INDIAN RIVER BLVD
Mailing Address - Street 2:STE A140
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7106
Mailing Address - Country:US
Mailing Address - Phone:772-770-2225
Mailing Address - Fax:772-770-6062
Practice Address - Street 1:1515 INDIAN RIVER BLVD
Practice Address - Street 2:STE A140
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7106
Practice Address - Country:US
Practice Address - Phone:772-770-2225
Practice Address - Fax:772-770-6062
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2013-05-14
Deactivation Date:2006-10-27
Deactivation Code:
Reactivation Date:2007-10-11
Provider Licenses
StateLicense IDTaxonomies
FLDN159481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice