Provider Demographics
NPI:1972601417
Name:GIDEL, CLAY M (DDS)
Entity type:Individual
Prefix:MR
First Name:CLAY
Middle Name:M
Last Name:GIDEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 DAVISON COURT
Mailing Address - Street 2:
Mailing Address - City:COLUSA
Mailing Address - State:CA
Mailing Address - Zip Code:95932
Mailing Address - Country:US
Mailing Address - Phone:530-458-2101
Mailing Address - Fax:530-458-2106
Practice Address - Street 1:3000 DAVISON COURT
Practice Address - Street 2:
Practice Address - City:COLUSA
Practice Address - State:CA
Practice Address - Zip Code:95932
Practice Address - Country:US
Practice Address - Phone:530-458-2101
Practice Address - Fax:530-458-2106
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32079122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist