Provider Demographics
NPI:1780264234
Name:MCLEMORE DENTISTRY, LLC
Entity type:Organization
Organization Name:MCLEMORE DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELCOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-277-9570
Mailing Address - Street 1:5740 CARMICHAEL RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-2312
Mailing Address - Country:US
Mailing Address - Phone:334-277-9570
Mailing Address - Fax:334-277-0152
Practice Address - Street 1:5740 CARMICHAEL RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-2312
Practice Address - Country:US
Practice Address - Phone:334-277-9570
Practice Address - Fax:334-277-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-09
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental