Provider Demographics
NPI:1417542499
Name:MCLAUGHLIN SPENDLOVE PLLC
Entity Type:Organization
Organization Name:MCLAUGHLIN SPENDLOVE PLLC
Other - Org Name:MCLAUGHLIN SPENDLOVE ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-814-2990
Mailing Address - Street 1:940 N SWITZER CANYON DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-4852
Mailing Address - Country:US
Mailing Address - Phone:928-779-4568
Mailing Address - Fax:
Practice Address - Street 1:940 N SWITZER CANYON DR STE 201
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4852
Practice Address - Country:US
Practice Address - Phone:928-779-4568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ090118Medicaid