Provider Demographics
NPI:1528459757
Name:CLEAR TAB DENTISTRY PC
Entity type:Organization
Organization Name:CLEAR TAB DENTISTRY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAY
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:AINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-601-8316
Mailing Address - Street 1:8120 LAKEVIEW PKWY # 300
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-4361
Mailing Address - Country:US
Mailing Address - Phone:214-601-8316
Mailing Address - Fax:
Practice Address - Street 1:8120 LAKEVIEW PKWY # 300
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4361
Practice Address - Country:US
Practice Address - Phone:214-601-8316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23386122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty