| NPI | 1598903973 |
|---|---|
| Doing Business As | SHADY SPRING DENTAL CARE |
| Entity Type | Organization |
| Authorized Contact | CARL JEFFREY CLAY General Partner 304-763-4665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WV 2683) |
| Additional Taxonomies | 122300000X Dentist (Licence: WV 3728) |
| 122300000X Dentist (Licence: WV 3776) | |
| Enumeration Date | 2009-01-23 |
| Last Update Date | 2009-01-26 |