Provider Demographics
NPI:1336212356
Name:MCCLUNG, TAMMY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:L
Last Name:MCCLUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 BIRCH AVENUE
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424
Mailing Address - Country:US
Mailing Address - Phone:541-942-2673
Mailing Address - Fax:541-942-9318
Practice Address - Street 1:1325 BIRCH AVENUE
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424
Practice Address - Country:US
Practice Address - Phone:541-942-2471
Practice Address - Fax:541-942-9318
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD6861122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist