Active NPI
Jerry Todd McClaran, D.M.D
- General Practice Dentistry
- Cape Coral, FL
National Provider Identifier
1801969282
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 18152
- Practice address
- 2688 Sunset Lake Drive
Cape Coral, FL 33909 - Phone
- (954) 401-3362
- NPI assigned
- Nov 15, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 18152 | FL | Primary |
Addresses
Primary practice location
2688 Sunset Lake Drive
Cape Coral, FL 33909
Mailing address
2688 Sunset Lake Drive
Cape Coral, FL 33909
Phone (954) 401-3362
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18152 | FL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1290556800000",
"number": "1801969282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2688 SUNSET LAKE DRIVE",
"city": "CAPE CORAL",
"state": "FL",
"postal_code": "33909",
"telephone_number": "954-401-3362"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2688 SUNSET LAKE DRIVE",
"city": "CAPE CORAL",
"state": "FL",
"postal_code": "33909",
"telephone_number": "954-401-3362"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCLARAN",
"first_name": "JERRY",
"middle_name": "TODD",
"name_prefix": "Dr.",
"credential": "D.M.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-15",
"last_updated": "2010-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "FL",
"license": "18152",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cape Coral, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.