Provider Demographics
NPI:1790798049
Name:MCLEAN, CHRIS A (DDS)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:A
Last Name:MCLEAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 TAWNY CT
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3916
Mailing Address - Country:US
Mailing Address - Phone:909-861-4448
Mailing Address - Fax:
Practice Address - Street 1:810 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3808
Practice Address - Country:US
Practice Address - Phone:714-525-4313
Practice Address - Fax:714-525-3694
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA264801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice