Provider Demographics
NPI:1164793543
Name:CLARK, HAYS AND ASSOCIATES, PLLC
Entity type:Organization
Organization Name:CLARK, HAYS AND ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BEBE
Authorized Official - Middle Name:G
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-863-2377
Mailing Address - Street 1:4558 CAPITAL BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-4537
Mailing Address - Country:US
Mailing Address - Phone:919-861-7814
Mailing Address - Fax:919-861-7819
Practice Address - Street 1:104 FOURTH ST
Practice Address - Street 2:
Practice Address - City:BLADENBORO
Practice Address - State:NC
Practice Address - Zip Code:28320-9407
Practice Address - Country:US
Practice Address - Phone:910-863-2377
Practice Address - Fax:910-863-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7917122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty