Provider Demographics
NPI:1356606461
Name:MCLAIN SURGICAL ARTS
Entity type:Organization
Organization Name:MCLAIN SURGICAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:LANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DMD
Authorized Official - Phone:256-429-3411
Mailing Address - Street 1:2045 CECIL ASHBURN DR SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-2563
Mailing Address - Country:US
Mailing Address - Phone:256-429-3411
Mailing Address - Fax:256-429-3413
Practice Address - Street 1:2045 CECIL ASHBURN DR SE
Practice Address - Street 2:SUITE 101
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-2563
Practice Address - Country:US
Practice Address - Phone:256-429-3411
Practice Address - Fax:256-429-3413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5212261QS0112X
AL28817261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery