Provider Demographics
NPI:1932505864
Name:MCCLARY, SCOTT NETTLES (DMD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:NETTLES
Last Name:MCCLARY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 SPRUILL AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-4764
Mailing Address - Country:US
Mailing Address - Phone:843-744-0311
Mailing Address - Fax:
Practice Address - Street 1:4515 SPRUILL AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-4764
Practice Address - Country:US
Practice Address - Phone:843-744-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC41361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice