Provider Demographics
NPI:1619422607
Name:SHAWN A. MCCLURE DMD, MD
Entity Type:Organization
Organization Name:SHAWN A. MCCLURE DMD, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD, MD
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:954-328-3631
Mailing Address - Street 1:9858 CLINT MOORE RD
Mailing Address - Street 2:C111-274
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-1034
Mailing Address - Country:US
Mailing Address - Phone:561-482-1144
Mailing Address - Fax:561-482-1145
Practice Address - Street 1:8755 SW 57TH PL
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-5921
Practice Address - Country:US
Practice Address - Phone:954-328-3631
Practice Address - Fax:954-355-5490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME990102086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Single Specialty