Provider Demographics
NPI:1245320449
Name:MARK L. MCCLENDON, PA
Entity type:Organization
Organization Name:MARK L. MCCLENDON, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:LESTER
Authorized Official - Last Name:MCCLENDON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:863-494-6116
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0011846122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty