Healthcare Provider Details

I. General information

NPI: 1902842032
Provider Name (Legal Business Name): SCOTT MCCLURE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14201 NE 20TH AVE SUITE 1101
VANCOUVER WA
98686-6410
US

IV. Provider business mailing address

14201NE 20TH AVE STE 2204
VANCOUVER WA
98686
US

V. Phone/Fax

Practice location:
  • Phone: 360-882-0222
  • Fax: 360-546-3355
Mailing address:
  • Phone: 360-571-8181
  • Fax: 360-573-4029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE5287
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: