Provider Demographics
NPI:1740482223
Name:MCCLUNG, ALICIA LANG (DMD)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:LANG
Last Name:MCCLUNG
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 1:6224 PORTSMOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-1345
Mailing Address - Country:US
Mailing Address - Phone:757-488-8884
Mailing Address - Fax:
Practice Address - Street 1:6224 PORTSMOUTH BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-1345
Practice Address - Country:US
Practice Address - Phone:757-488-8884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014118081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice