Provider Demographics
NPI:1861473332
Name:MCLEAN, DALE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:
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 1:4755 NC HWY 9 SOUTH
Mailing Address - Street 2:
Mailing Address - City:TRYON
Mailing Address - State:NC
Mailing Address - Zip Code:28782
Mailing Address - Country:US
Mailing Address - Phone:828-692-4289
Mailing Address - Fax:828-692-4396
Practice Address - Street 1:2595 CHIMNEY ROCK RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-9181
Practice Address - Country:US
Practice Address - Phone:828-692-4289
Practice Address - Fax:828-692-4396
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7721122300000X, 1223D0001X, 1223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223D0001XDental ProvidersDentistDental Public Health
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902PTMedicaid
NC0147GOtherBCBS
NC344556DMedicaid