Provider Demographics
NPI:1780612820
Name:MCCLAVE, RICHARD (DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:MCCLAVE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 CUTLER AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1714
Mailing Address - Country:US
Mailing Address - Phone:443-694-2185
Mailing Address - Fax:
Practice Address - Street 1:1231 CANDELARIA RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-2767
Practice Address - Country:US
Practice Address - Phone:505-345-8309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD135081223G0001X
NMDD30631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice