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General NPI Number Information
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NPI Number | 1073766564
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Entity Type | Organization
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Legal Business Name | MCCLURE DENTAL SERVICES
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 10/28/2008
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Provider Practice Location Address
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Address Line | 844 W DELAVAN AVE
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City | BUFFALO
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State | NY
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Zip | 14209-1113
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Country | US
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Telephone | 716-886-1166
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Fax | 716-883-6541
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Provider Business Mailing Address
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Address Line | 844 W DELAVAN AVE
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City | BUFFALO
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State | NY
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Zip | 14209-1113
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Country | US
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Telephone | 716-886-1166
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Fax | 716-883-6541
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Authorized Official
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Title or Position | PRESIDENT
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Name | CRAIG ALAN MCCLURE
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Credential | D.D.S.
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Telephone | 716-886-1166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 037529
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License Number State | NY
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