Healthcare Provider Details

I. General information

NPI: 1073030169
Provider Name (Legal Business Name): DR. MCCLARY & ASSOCIATES III, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 09/22/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 WONDER DR STE C
KANNAPOLIS NC
28083-6690
US

IV. Provider business mailing address

PO BOX 860036
MINNEAPOLIS MN
55486-0036
US

V. Phone/Fax

Practice location:
  • Phone: 704-934-2003
  • Fax:
Mailing address:
  • Phone: 480-893-0888
  • Fax: 216-584-1301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LAUREN HILL
Title or Position: DIRECTOR, RCM
Credential:
Phone: 972-930-7707