Provider Demographics
NPI:1932279775
Name:MCLEAN, MARY ELLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELLEN
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1011 N UNIVERSITY AVE
Mailing Address - Street 2:UNIVERSITY OF MICHIGAN SCHOOL OF DENTISTRY
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-1012
Mailing Address - Country:US
Mailing Address - Phone:734-764-3155
Mailing Address - Fax:734-615-4784
Practice Address - Street 1:1011 N UNIVERSITY AVE
Practice Address - Street 2:UNIVERSITY OF MICHIGAN SCHOOL OF DENTISTRY
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-1012
Practice Address - Country:US
Practice Address - Phone:734-764-3155
Practice Address - Fax:734-615-4784
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI29010171441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID171440OtherBCBS OF MI DENTAL