Provider Demographics
NPI:1376841684
Name:STEPHEN M. MCLEAN, D.M.D.,P.C.
Entity Type:Organization
Organization Name:STEPHEN M. MCLEAN, D.M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-963-0924
Mailing Address - Street 1:1809 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-2244
Mailing Address - Country:US
Mailing Address - Phone:541-963-0924
Mailing Address - Fax:541-962-0924
Practice Address - Street 1:1809 3RD ST
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2244
Practice Address - Country:US
Practice Address - Phone:541-963-0924
Practice Address - Fax:541-962-0924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD89981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty