Provider Demographics
NPI:1003021460
Name:MCCLOY, JAMES L (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:MCCLOY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-2091
Mailing Address - Country:US
Mailing Address - Phone:724-547-9105
Mailing Address - Fax:724-547-3138
Practice Address - Street 1:101 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-2091
Practice Address - Country:US
Practice Address - Phone:724-547-9105
Practice Address - Fax:724-547-3138
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0169701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice