Provider Demographics
NPI:1619022019
Name:MCCLEAN, LU ANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:LU
Middle Name:ANNE
Last Name:MCCLEAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 S 36TH ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-5807
Mailing Address - Country:US
Mailing Address - Phone:217-224-0426
Mailing Address - Fax:217-224-1402
Practice Address - Street 1:332 S 36TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-5807
Practice Address - Country:US
Practice Address - Phone:217-224-0426
Practice Address - Fax:217-224-1402
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist