Provider Demographics
NPI:1568626810
Name:PATRICK J MCCLELLAN DDS, INC.
Entity Type:Organization
Organization Name:PATRICK J MCCLELLAN DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCLELLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-229-8100
Mailing Address - Street 1:910 LOUISIANA ST
Mailing Address - Street 2:SUITE 190
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-4916
Mailing Address - Country:US
Mailing Address - Phone:713-229-8100
Mailing Address - Fax:713-229-9241
Practice Address - Street 1:910 LOUISIANA ST
Practice Address - Street 2:SUITE 190
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-4916
Practice Address - Country:US
Practice Address - Phone:713-229-8100
Practice Address - Fax:713-229-9241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty