Provider Demographics
NPI:1730319781
Name:MCLEAN, ERIC ALEXANDER (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ALEXANDER
Last Name:MCLEAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10674 WILLIAMSBURG TRL
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-2211
Mailing Address - Country:US
Mailing Address - Phone:815-260-3729
Mailing Address - Fax:
Practice Address - Street 1:7345 W. 25TH STREET
Practice Address - Street 2:
Practice Address - City:NORTH RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546
Practice Address - Country:US
Practice Address - Phone:312-274-0308
Practice Address - Fax:312-944-9499
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028079122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist