Provider Demographics
NPI:1619003340
Name:CLAY, TIMOTHY JON (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JON
Last Name:CLAY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19804-3910
Mailing Address - Country:US
Mailing Address - Phone:302-998-0500
Mailing Address - Fax:302-993-0784
Practice Address - Street 1:533 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19804-3910
Practice Address - Country:US
Practice Address - Phone:302-998-0500
Practice Address - Fax:302-993-0784
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00009341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice