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NPI Code Detail

MEDICARE: SCOTT NETTLES MCCLARY D.M.D.

MEDICARE: SCOTT NETTLES MCCLARY D.M.D.
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
11223G0001XGeneral Practice Dentistry4136SC

General Provider Information

NPI Number : 1932505864
Entity Type Code : Individual
Provider Name (Legal Business Name) : SCOTT NETTLES MCCLARY D.M.D.
Provider Business Mailing Address
First Line : 4515 SPRUILL AVE
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29405-4764
Country : US
Telephone Number : 843-744-0311
Fax Number :
Provider Business Practice Location Address
First Line : 4515 SPRUILL AVE
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29405-4764
Country : US
Telephone Number : 843-744-0311
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2014
Last Update Date : 11/04/2014

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Directions to “ SCOTT NETTLES MCCLARY D.M.D.” Practice Location

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