Provider Demographics
NPI:1962428946
Name:MCCLUNG, RICHARD EUGENE (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EUGENE
Last Name:MCCLUNG
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 1:200 E RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-1130
Mailing Address - Country:US
Mailing Address - Phone:304-645-2088
Mailing Address - Fax:304-645-2155
Practice Address - Street 1:200 E RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-1130
Practice Address - Country:US
Practice Address - Phone:304-645-2088
Practice Address - Fax:304-645-2155
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2125/651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0135641000Medicaid