Provider Demographics
NPI:1922094176
Name:MCCLENDON, MARK LESTER (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:LESTER
Last Name:MCCLENDON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:L
Other - Last Name:MCCLENDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:1020 N MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34266-8811
Mailing Address - Country:US
Mailing Address - Phone:863-494-6116
Mailing Address - Fax:863-494-2660
Practice Address - Street 1:1020 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-8811
Practice Address - Country:US
Practice Address - Phone:863-494-6116
Practice Address - Fax:863-494-2660
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00118461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice