Provider Demographics
NPI:1427933837
Name:CARSON, MCCLAY IRENE (RDH, CDHC)
Entity type:Individual
Prefix:MRS
First Name:MCCLAY
Middle Name:IRENE
Last Name:CARSON
Suffix:
Gender:F
Credentials:RDH, CDHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1949 STATE HIGHWAY 143
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:MO
Mailing Address - Zip Code:63956-7184
Mailing Address - Country:US
Mailing Address - Phone:205-331-7120
Mailing Address - Fax:
Practice Address - Street 1:1 HALS PLZ STE B
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:MO
Practice Address - Zip Code:63957-1631
Practice Address - Country:US
Practice Address - Phone:573-223-8902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020016624124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist