Provider Demographics
NPI:1902173206
Name:ROBERT MCCLURG, DDS A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:ROBERT MCCLURG, DDS A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:DR. MCCLURG'S SMILE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-381-7171
Mailing Address - Street 1:8689 FOLSOM BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-3708
Mailing Address - Country:US
Mailing Address - Phone:916-381-7171
Mailing Address - Fax:916-381-1171
Practice Address - Street 1:8689 FOLSOM BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3708
Practice Address - Country:US
Practice Address - Phone:916-381-7171
Practice Address - Fax:916-381-1171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA259451223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty