Provider Demographics
NPI:1497974869
Name:MCCLANE, MICHAEL CALVIN (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CALVIN
Last Name:MCCLANE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 LA HABRA BLVD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631
Mailing Address - Country:US
Mailing Address - Phone:562-698-6684
Mailing Address - Fax:562-905-2604
Practice Address - Street 1:2501 LA HABRA BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631
Practice Address - Country:US
Practice Address - Phone:562-698-6684
Practice Address - Fax:562-905-2604
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice