Provider Demographics
NPI:1235335506
Name:MCCLELLAN, CHAD J (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:J
Last Name:MCCLELLAN
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 1:8602 S 100TH ST
Mailing Address - Street 2:
Mailing Address - City:LAVISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-3074
Mailing Address - Country:US
Mailing Address - Phone:402-560-1790
Mailing Address - Fax:
Practice Address - Street 1:140 E 22ND ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2667
Practice Address - Country:US
Practice Address - Phone:402-727-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6713122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist