MEDICARE: DR. JENNIFER CLYBURN MCMASTER DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	4464	SC

General Provider Information

NPI Number	:	1508029901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER CLYBURN MCMASTER DMD

Provider Business Mailing Address
First Line	:	4171 MARLEY CT
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-7602
Country	:	US
Telephone Number	:	803-427-2653
Fax Number	:

Provider Business Practice Location Address
First Line	:	4171 MARLEY CT
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-7602
Country	:	US
Telephone Number	:	803-427-2653
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2008
Last Update Date	:	08/20/2021

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