Provider Demographics
NPI:1750684478
Name:KATHRYN C MCCLINTOCK DDS
Entity Type:Organization
Organization Name:KATHRYN C MCCLINTOCK DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:CARREL
Authorized Official - Last Name:MCCLINTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:727-391-1963
Mailing Address - Street 1:15215 GULF BLVD
Mailing Address - Street 2:
Mailing Address - City:MADEIRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33708-1814
Mailing Address - Country:US
Mailing Address - Phone:727-391-1963
Mailing Address - Fax:727-393-9580
Practice Address - Street 1:15215 GULF BLVD
Practice Address - Street 2:
Practice Address - City:MADEIRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33708-1814
Practice Address - Country:US
Practice Address - Phone:727-391-1963
Practice Address - Fax:727-393-9580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 89291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty