Provider Demographics
NPI:1508521394
Name:GRANT D. MCCLENDON DMD PLLC
Entity Type:Organization
Organization Name:GRANT D. MCCLENDON DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLENDON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-885-3207
Mailing Address - Street 1:1118 FINNEGAN WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-6656
Mailing Address - Country:US
Mailing Address - Phone:360-676-0760
Mailing Address - Fax:
Practice Address - Street 1:1118 FINNEGAN WAY STE 101
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-6656
Practice Address - Country:US
Practice Address - Phone:360-676-0760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty