Provider Demographics
NPI:1619424611
Name:BRYAN W. MCLELLAND, D.D.S., P.S.
Entity Type:Organization
Organization Name:BRYAN W. MCLELLAND, D.D.S., P.S.
Other - Org Name:LIBERTY ORAL & FACIAL SURGERY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER / ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLELLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-939-7684
Mailing Address - Street 1:602 N CALGARY CT
Mailing Address - Street 2:SUITE 202
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-4000
Mailing Address - Country:US
Mailing Address - Phone:208-262-2660
Mailing Address - Fax:509-344-1113
Practice Address - Street 1:602 N CALGARY CT
Practice Address - Street 2:SUITE 202
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-4000
Practice Address - Country:US
Practice Address - Phone:208-262-2660
Practice Address - Fax:509-344-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery