Provider Demographics
NPI:1942414446
Name:MCCLURE, SCOTT RYAN (DDS MS)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:RYAN
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ARAPAHOE ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2752
Mailing Address - Country:US
Mailing Address - Phone:860-233-9609
Mailing Address - Fax:860-232-8287
Practice Address - Street 1:8 ARAPAHOE RD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2752
Practice Address - Country:US
Practice Address - Phone:860-233-9609
Practice Address - Fax:860-232-8287
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT95221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics