Provider Demographics
NPI:1215529235
Name:MCLAGAN, RAYMOND LLOYD
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:LLOYD
Last Name:MCLAGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-4419
Mailing Address - Country:US
Mailing Address - Phone:573-239-0087
Mailing Address - Fax:
Practice Address - Street 1:111 VISTA DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-4419
Practice Address - Country:US
Practice Address - Phone:573-239-0087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000121851223G0001X, 1223X0400X
GADN1232751223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice