Provider Demographics
NPI:1609163773
Name:MCCLELLAN, MORGAN E (DDS)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:E
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1953 POTTERY AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-2558
Mailing Address - Country:US
Mailing Address - Phone:360-876-6211
Mailing Address - Fax:
Practice Address - Street 1:1953 POTTERY AVE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-2558
Practice Address - Country:US
Practice Address - Phone:360-876-6211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020427122300000X
WADE60575899122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist