Provider Demographics
NPI:1811910292
Name:MACLEAN, DEREK CAMERON (DDS)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:CAMERON
Last Name:MACLEAN
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 1:866 SEVEN HILLS DR
Mailing Address - Street 2:#104
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052
Mailing Address - Country:US
Mailing Address - Phone:702-567-5449
Mailing Address - Fax:702-450-5490
Practice Address - Street 1:866 SEVEN HILLS DR
Practice Address - Street 2:#104
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-567-5449
Practice Address - Fax:702-450-5490
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3191122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist