Park W McClung, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

D6947 Issued in OR

Practice address

1325 Birch Ave
Cottage Grove, OR 97424-1416

Phone

(541) 942-2471

Fax

(541) 942-9318

NPI assigned

Nov 15, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Birch Avenue Dental, Inc.

  • Dentist
  • Cottage Grove, OR
  • NPI 1841363348
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1144393646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 BIRCH AVE",
            "city": "COTTAGE GROVE",
            "state": "OR",
            "postal_code": "974241416",
            "telephone_number": "541-942-2471",
            "fax_number": "541-942-9318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 BIRCH AVE",
            "city": "COTTAGE GROVE",
            "state": "OR",
            "postal_code": "974241416",
            "telephone_number": "541-942-2471",
            "fax_number": "541-942-9318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCLUNG",
        "first_name": "PARK",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D6947",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Michelle Marsh
• Therese N Mastin, M.A., QMHP
• Rebecca McBride, APN
• Matthew McCallum
• Julie A McClary
• Tammy L McClung, D.D.S.
• John McClure, QMHA
• Howard Keith McConnell, PHD
• Patricia McConnell
• Cynthia Lynn McCourt

• Dentist in Cottage Grove, OR
• Providers in Cottage Grove, OR by specialty
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.