Provider Demographics
NPI:1215925276
Name:MCCLURE, RONALD PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:PAUL
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 MAIN AVE
Mailing Address - Street 2:SUITE 705
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1971
Mailing Address - Country:US
Mailing Address - Phone:701-237-4341
Mailing Address - Fax:701-297-5938
Practice Address - Street 1:520 MAIN AVE
Practice Address - Street 2:SUITE 705
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1971
Practice Address - Country:US
Practice Address - Phone:701-237-4341
Practice Address - Fax:701-297-5938
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND14871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND40485Medicaid
ND901487OtherBCBS/DSC