Provider Demographics
NPI:1457609281
Name:MCCLATCHEY, CORI (DMD)
Entity Type:Individual
Prefix:DR
First Name:CORI
Middle Name:
Last Name:MCCLATCHEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 REILLY ROAD
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-7302
Mailing Address - Country:US
Mailing Address - Phone:910-643-2196
Mailing Address - Fax:910-396-7017
Practice Address - Street 1:7101 HOFF ST BLDG 9240
Practice Address - Street 2:
Practice Address - City:FORT MOORE
Practice Address - State:GA
Practice Address - Zip Code:31905-5645
Practice Address - Country:US
Practice Address - Phone:541-231-4233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8351248-99231223G0001X
UT8351248-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist