Provider Demographics
NPI:1184623738
Name:MCLEARAN, SUSAN H (RDHAP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:H
Last Name:MCLEARAN
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 E BUENA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-2365
Mailing Address - Country:US
Mailing Address - Phone:559-733-2355
Mailing Address - Fax:559-625-4578
Practice Address - Street 1:2010 E BUENA VISTA AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292-2365
Practice Address - Country:US
Practice Address - Phone:559-733-2355
Practice Address - Fax:559-625-4578
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP 82124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA147060OtherDELTA DENTAL
CA522590OtherMEDI-CAL AND CCS/GHPP