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General NPI Number Information
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NPI Number | 1710137559
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Entity Type | Organization
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Legal Business Name | SCOTT R MCCLURE DDS MS PA
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Dates
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Enumeration Date | 09/29/2008
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Last Update Date | 09/29/2008
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Provider Practice Location Address
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Address Line | 4601 LAKE BOONE TRL SUITE 1A
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City | RALEIGH
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State | NC
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Zip | 27607-7503
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Country | US
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Telephone | 919-786-4470
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Fax | 919-786-4471
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Provider Business Mailing Address
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Address Line | 4601 LAKE BOONE TRL SUITE 1A
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City | RALEIGH
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State | NC
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Zip | 27607-7503
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Country | US
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Telephone | 919-786-4470
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Fax | 919-786-4471
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SCOTT RYAN MCCLURE
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Credential | D.D.S., M.S.
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Telephone | 919-786-4470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 8662
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License Number State | NC
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