Provider Demographics
NPI:1700031291
Name:MCCLARY, PHILLIP G (DMD; MSCO)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:G
Last Name:MCCLARY
Suffix:
Gender:M
Credentials:DMD; MSCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 HIGHWAY 72 BYPASS WEST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649
Mailing Address - Country:US
Mailing Address - Phone:864-223-7756
Mailing Address - Fax:864-323-0056
Practice Address - Street 1:849 HIGHWAY 72 BYPASS WEST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649
Practice Address - Country:US
Practice Address - Phone:864-223-7756
Practice Address - Fax:864-323-0056
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC176-16461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics