Healthcare Provider Details

I. General information

NPI: 1457609281
Provider Name (Legal Business Name): CORI MCCLATCHEY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 HOFF ST BLDG 9240
FORT BENNING GA
31905-5645
US

IV. Provider business mailing address

2817 REILLY ROAD
FORT BRAGG NC
28310-7302
US

V. Phone/Fax

Practice location:
  • Phone: 706-544-4795
  • Fax:
Mailing address:
  • Phone: 910-643-2196
  • Fax: 910-396-7017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number8351248-9922
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8351248-9923
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: