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NPI Code Detail

MEDICARE: DR. PARK W MCCLUNG D.D.S.

MEDICARE: DR. PARK W MCCLUNG D.D.S.
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
1122300000XDentistD6947OR

General Provider Information

NPI Number : 1144393646
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PARK W MCCLUNG D.D.S.
Provider Business Mailing Address
First Line : 1325 BIRCH AVE
Second Line :
City : COTTAGE GROVE
State : OR
Zip : 97424-1416
Country : US
Telephone Number : 541-942-2471
Fax Number : 541-942-9318
Provider Business Practice Location Address
First Line : 1325 BIRCH AVE
Second Line :
City : COTTAGE GROVE
State : OR
Zip : 97424-1416
Country : US
Telephone Number : 541-942-2471
Fax Number : 541-942-9318
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2006
Last Update Date : 07/08/2007

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