Provider Demographics
NPI:1821295718
Name:MACLEOD, MARILYN ELAINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:ELAINE
Last Name:MACLEOD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MEETING HOUSE RD
Mailing Address - Street 2:TEAMSTERS DENTAL
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2766
Mailing Address - Country:US
Mailing Address - Phone:978-256-9728
Mailing Address - Fax:
Practice Address - Street 1:4 MEETING HOUSE RD
Practice Address - Street 2:TEAMSTERS DENTAL
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2766
Practice Address - Country:US
Practice Address - Phone:978-256-9728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA153541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice