Provider Demographics
NPI:1619079175
Name:MCCLEVE, JOHN BRUCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRUCE
Last Name:MCCLEVE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:361 N 1ST ST
Mailing Address - Street 2:APT. 4
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-1330
Mailing Address - Country:US
Mailing Address - Phone:408-674-4357
Mailing Address - Fax:408-356-8170
Practice Address - Street 1:751 BLOSSOM HILL RD
Practice Address - Street 2:SUITE C
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-3583
Practice Address - Country:US
Practice Address - Phone:408-356-6650
Practice Address - Fax:408-356-8170
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice