Provider Demographics
NPI:1194182139
Name:MCCLURE, ANN MARGARET (RDA)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARGARET
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 DEEPWATER AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-1520
Mailing Address - Country:US
Mailing Address - Phone:310-908-4323
Mailing Address - Fax:
Practice Address - Street 1:1618 DEEPWATER AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-1520
Practice Address - Country:US
Practice Address - Phone:310-908-4323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDA60980126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant