Provider Demographics
NPI:1578606083
Name:MCCLARY, SAMUEL A (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:A
Last Name:MCCLARY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16410 SMOKEY POINT BLVD.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223
Mailing Address - Country:US
Mailing Address - Phone:360-651-1359
Mailing Address - Fax:360-659-1275
Practice Address - Street 1:16410 SMOKEY POINT BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8415
Practice Address - Country:US
Practice Address - Phone:360-651-1359
Practice Address - Fax:360-659-1275
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000055241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5010301Medicaid
WA86311OtherLABOR & INDUSTRIES
WA0900004608OtherMEDICARE RAILROAD
WA5010301Medicaid