Provider Demographics
NPI:1750505715
Name:MCCLATCHEY, LAURIE MCNAMARA (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:MCNAMARA
Last Name:MCCLATCHEY
Suffix:
Gender:F
Credentials:DDS MS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2619 PIN OAK DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-2370
Mailing Address - Country:US
Mailing Address - Phone:734-996-9190
Mailing Address - Fax:
Practice Address - Street 1:321 N INGALLS ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-1513
Practice Address - Country:US
Practice Address - Phone:734-668-8288
Practice Address - Fax:734-668-8110
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010184371223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics