Provider Demographics
NPI:1427198399
Name:MCLENDON, EARL F (DMD)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:F
Last Name:MCLENDON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 SCENIC HWY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-6362
Mailing Address - Country:US
Mailing Address - Phone:770-995-4262
Mailing Address - Fax:
Practice Address - Street 1:685 SCENIC HWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-6362
Practice Address - Country:US
Practice Address - Phone:770-995-4262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA109631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00450722CMedicaid
GA9752232OtherUNITED CONCORDIA
GA582201294OtherDELTA DENTAL
GA6743OtherDORAL DENTAL SERVICES
GA815505OtherTRICARE
GA100447OtherAVESIS