Provider Demographics
NPI:1780830489
Name:DR. MCCLARY & ASSOC. WAKE FOREST, P.A.
Entity Type:Organization
Organization Name:DR. MCCLARY & ASSOC. WAKE FOREST, P.A.
Other - Org Name:DENTALWORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLARY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:800-487-4867
Mailing Address - Street 1:P.O. BOX 860036
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486
Mailing Address - Country:US
Mailing Address - Phone:919-570-9898
Mailing Address - Fax:216-584-1120
Practice Address - Street 1:11480 CAPITAL BLVD.
Practice Address - Street 2:SUITE 115 CAVENESS FARMS
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4554
Practice Address - Country:US
Practice Address - Phone:919-570-9898
Practice Address - Fax:216-584-1120
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTALONE PARTNERS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-13
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty