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General NPI Number Information
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NPI Number | 1902173206
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Entity Type | Organization
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Legal Business Name | ROBERT MCCLURG, DDS A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 11/30/2011
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Last Update Date | 11/30/2011
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Provider Practice Location Address
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Address Line | 8689 FOLSOM BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95826-3708
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Country | US
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Telephone | 916-381-7171
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Fax | 916-381-1171
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Provider Business Mailing Address
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Address Line | 8689 FOLSOM BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95826-3708
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Country | US
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Telephone | 916-381-7171
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Fax | 916-381-1171
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. MARISSA MCCLURG
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Credential |
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Telephone | 916-381-7171
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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 | 25945
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License Number State | CA
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