Provider Demographics
NPI:1790909000
Name:PAUL MICHAEL MCLEOD DDS, INC.
Entity Type:Organization
Organization Name:PAUL MICHAEL MCLEOD DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:574-233-7331
Mailing Address - Street 1:51427 MEGAN CT
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-7832
Mailing Address - Country:US
Mailing Address - Phone:574-277-3532
Mailing Address - Fax:
Practice Address - Street 1:919 E JEFFERSON BLVD
Practice Address - Street 2:SUITE LL02
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-3112
Practice Address - Country:US
Practice Address - Phone:574-233-7331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009809A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty