MEDICARE: DR. JAMES T MCCLUNG JR. DDS

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	4673	VA

General Provider Information

NPI Number	:	1962472878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES T MCCLUNG JR. DDS

Provider Business Mailing Address
First Line	:	PO BOX 7889
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24019
Country	:	US
Telephone Number	:	540-362-5900
Fax Number	:	540-366-5131

Provider Business Practice Location Address
First Line	:	6035 PETERS CREEK RD
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24019-4029
Country	:	US
Telephone Number	:	540-362-5900
Fax Number	:	540-366-5131

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	12/14/2011

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