Healthcare Provider Details

I. General information

NPI: 1962472878
Provider Name (Legal Business Name): JAMES T MCCLUNG JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6035 PETERS CREEK RD
ROANOKE VA
24019-4029
US

IV. Provider business mailing address

PO BOX 7889
ROANOKE VA
24019
US

V. Phone/Fax

Practice location:
  • Phone: 540-362-5900
  • Fax: 540-366-5131
Mailing address:
  • Phone: 540-362-5900
  • Fax: 540-366-5131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4673
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: