Provider Demographics
NPI:1598903973
Name:CLAY AND HIENER DENTISTRY PARTNERSHIP
Entity Type:Organization
Organization Name:CLAY AND HIENER DENTISTRY PARTNERSHIP
Other - Org Name:SHADY SPRING DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-763-4665
Mailing Address - Street 1:479 FLAT TOP RD
Mailing Address - Street 2:
Mailing Address - City:SHADY SPRING
Mailing Address - State:WV
Mailing Address - Zip Code:25918-8614
Mailing Address - Country:US
Mailing Address - Phone:304-763-4665
Mailing Address - Fax:304-763-5172
Practice Address - Street 1:479 FLAT TOP RD
Practice Address - Street 2:
Practice Address - City:SHADY SPRING
Practice Address - State:WV
Practice Address - Zip Code:25918-8614
Practice Address - Country:US
Practice Address - Phone:304-763-4665
Practice Address - Fax:304-763-5172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2683122300000X
WV3728122300000X
WV3776122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1591884OtherUNITED CONCORDIA
WV001875982OtherMT STATE BLUE CROSS