Provider Demographics
NPI:1225210008
Name:MCLANE, DEIDRA ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEIDRA
Middle Name:ANN
Last Name:MCLANE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DEIDRA
Other - Middle Name:ANN
Other - Last Name:SCHELIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5000 W SLAUGHTER LN
Mailing Address - Street 2:STE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-3997
Mailing Address - Country:US
Mailing Address - Phone:512-292-8002
Mailing Address - Fax:512-292-8550
Practice Address - Street 1:5000 W SLAUGHTER LN
Practice Address - Street 2:STE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-3997
Practice Address - Country:US
Practice Address - Phone:512-292-8002
Practice Address - Fax:512-292-8550
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice