Provider Demographics
NPI:1932281284
Name:MCLEARY, MICHAEL DAVIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVIS
Last Name:MCLEARY
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 1:410 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-6131
Mailing Address - Country:US
Mailing Address - Phone:256-766-3811
Mailing Address - Fax:256-766-6567
Practice Address - Street 1:410 S PINE ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-6131
Practice Address - Country:US
Practice Address - Phone:256-766-3811
Practice Address - Fax:256-766-6567
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL48611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51515369OtherBLUE CROSS