Provider Demographics
NPI:1700947355
Name:ST CLAIR, JOHN ROBERT (DDS, MS, PA)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:ST CLAIR
Suffix:
Gender:M
Credentials:DDS, MS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5203 79TH ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-2850
Mailing Address - Country:US
Mailing Address - Phone:806-799-6780
Mailing Address - Fax:806-698-0668
Practice Address - Street 1:5203 79TH ST
Practice Address - Street 2:SUITE H
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2850
Practice Address - Country:US
Practice Address - Phone:806-799-6780
Practice Address - Fax:806-698-0668
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104571223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics