Provider Demographics
NPI:1841976941
Name:POWELSON, CLAY GARY (DMD)
Entity type:Individual
Prefix:DR
First Name:CLAY
Middle Name:GARY
Last Name:POWELSON
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:PO BOX 1107
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28638-1107
Mailing Address - Country:US
Mailing Address - Phone:828-726-0202
Mailing Address - Fax:828-728-0300
Practice Address - Street 1:3094 HICKORY BLVD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NC
Practice Address - Zip Code:28638-2659
Practice Address - Country:US
Practice Address - Phone:828-726-0202
Practice Address - Fax:828-728-0300
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13352122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist