MEDICARE: SCOTT L. MCCLURE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN8110	FL

General Provider Information

NPI Number	:	1053355529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT L. MCCLURE DDS

Provider Business Mailing Address
First Line	:	4708 26TH ST W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34207-1703
Country	:	US
Telephone Number	:	941-758-4543
Fax Number	:

Provider Business Practice Location Address
First Line	:	4708 26TH ST W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34207-1703
Country	:	US
Telephone Number	:	941-758-4543
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	07/08/2007

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