Provider Demographics
NPI:1497963326
Name:DONALD E CLELAND JR DDS PC
Entity Type:Organization
Organization Name:DONALD E CLELAND JR DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:CLELAND
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-349-3990
Mailing Address - Street 1:14600 S LA GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2555
Mailing Address - Country:US
Mailing Address - Phone:708-349-3990
Mailing Address - Fax:708-349-8938
Practice Address - Street 1:14600 S LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2555
Practice Address - Country:US
Practice Address - Phone:708-349-3990
Practice Address - Fax:708-349-8938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0144601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty