Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 12006315A | IN |
NPI | 1033237821 |
---|---|
Provider Name | Randall Mcclary |
First Address | Mayfield Hts, OH 44124-6502 |
Second Address | Mayfield Hts, OH 44124-6502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 08/07/2007 |