Provider Demographics
NPI:1689138224
Name:MCCLURE, MARTHA (RDH)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4493 LYNBROOK LOOP APT 3
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-7393
Mailing Address - Country:US
Mailing Address - Phone:530-604-4825
Mailing Address - Fax:
Practice Address - Street 1:1211 CORTINA DR
Practice Address - Street 2:
Practice Address - City:ORLAND
Practice Address - State:CA
Practice Address - Zip Code:95963-1699
Practice Address - Country:US
Practice Address - Phone:530-865-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH32081124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist