Provider Demographics
NPI:1932284452
Name:ROGER D. CLAY, D.D.S.,INC
Entity Type:Organization
Organization Name:ROGER D. CLAY, D.D.S.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-683-3274
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:
Mailing Address - City:SOPHIA
Mailing Address - State:WV
Mailing Address - Zip Code:25921-0300
Mailing Address - Country:US
Mailing Address - Phone:304-683-3274
Mailing Address - Fax:304-683-3885
Practice Address - Street 1:460 ROBERT C. BYRD DRIVE
Practice Address - Street 2:
Practice Address - City:SOPHIA
Practice Address - State:WV
Practice Address - Zip Code:25921
Practice Address - Country:US
Practice Address - Phone:304-683-3274
Practice Address - Fax:304-683-3885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV26261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty