Provider Demographics
NPI:1902013881
Name:ST. CLAIR AND ST. CLAIR ORTHODONTICS
Entity Type:Organization
Organization Name:ST. CLAIR AND ST. CLAIR ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ST. CLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:806-799-6780
Mailing Address - Street 1:5203 79TH ST STE H
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-2894
Mailing Address - Country:US
Mailing Address - Phone:806-799-6780
Mailing Address - Fax:806-698-0668
Practice Address - Street 1:5203 79TH ST STE H
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2894
Practice Address - Country:US
Practice Address - Phone:806-799-6780
Practice Address - Fax:806-698-0668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104571223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty