Provider Demographics
NPI:1447386297
Name:MCCLINTOCK, KATHRYN C (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:C
Last Name:MCCLINTOCK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15215 GULF BLVD
Mailing Address - Street 2:
Mailing Address - City:MADEIRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33708
Mailing Address - Country:US
Mailing Address - Phone:727-391-1963
Mailing Address - Fax:727-393-9580
Practice Address - Street 1:15215 GULF BLVD
Practice Address - Street 2:
Practice Address - City:MADEIRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33708-1814
Practice Address - Country:US
Practice Address - Phone:727-391-1963
Practice Address - Fax:727-393-9580
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN8929122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist