Provider Demographics
NPI:1205919719
Name:ROGER D. CLAY, D.D.S., P.A.
Entity type:Organization
Organization Name:ROGER D. CLAY, D.D.S., P.A.
Other - Org Name:<UNAVAIL>
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:772-770-2225
Mailing Address - Street 1:1515 INDIAN RIVER BLVD STE A140
Mailing Address - Street 2:
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:
Practice Address - Street 1:1515 INDIAN RIVER BLVD STE A140
Practice Address - Street 2:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-21
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN159481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty