Provider Demographics
NPI:1497219489
Name:JACKQUELINE MCLEAN DDS LLC
Entity Type:Organization
Organization Name:JACKQUELINE MCLEAN DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACKQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-549-9099
Mailing Address - Street 1:3738 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-1020
Mailing Address - Country:US
Mailing Address - Phone:203-549-9099
Mailing Address - Fax:203-549-9820
Practice Address - Street 1:3738 PARK AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-1020
Practice Address - Country:US
Practice Address - Phone:203-549-9099
Practice Address - Fax:203-549-9820
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACKQUELINE MCLEAN DDS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty