Provider Demographics
NPI:1821174293
Name:MICHAEL P. MCCLAIN, D.M.D., PC
Entity Type:Organization
Organization Name:MICHAEL P. MCCLAIN, D.M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PICKARD
Authorized Official - Last Name:MCCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:731-644-9311
Mailing Address - Street 1:1405 E WOOD ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-5655
Mailing Address - Country:US
Mailing Address - Phone:731-644-9311
Mailing Address - Fax:731-644-9313
Practice Address - Street 1:1405 E WOOD ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-5655
Practice Address - Country:US
Practice Address - Phone:731-644-9311
Practice Address - Fax:731-644-9313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-28
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000043071223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0006647Medicaid