Provider Demographics
NPI:1780692970
Name:SCOTT M. CLINARD, D.D.S., P.A.
Entity type:Organization
Organization Name:SCOTT M. CLINARD, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLINARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-864-8896
Mailing Address - Street 1:571 COX RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0632
Mailing Address - Country:US
Mailing Address - Phone:704-864-8896
Mailing Address - Fax:704-865-3879
Practice Address - Street 1:571 COX RD
Practice Address - Street 2:SUITE A
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054
Practice Address - Country:US
Practice Address - Phone:704-864-8896
Practice Address - Fax:704-865-3879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC41821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC91669OtherBLUE CROSS PROVIDER NUMBE
NC465292OtherUNITED CONCORDIA PROVIDER
NC465292OtherUNITED CONCORDIA PROVIDER