MEDICARE: DR. JACKIE S. MCCLAIN D.D.S. , P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS 7273	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DS 7273	OTHER	TN	LICENSE NUMBER

General Provider Information

NPI Number	:	1891881348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACKIE S. MCCLAIN D.D.S. , P.C.

Provider Business Mailing Address
First Line	:	1030 MULBERRY AVE
Second Line	:
City	:	SELMER
State	:	TN
Zip	:	38375-6629
Country	:	US
Telephone Number	:	731-646-0021
Fax Number	:	731-434-0382

Provider Business Practice Location Address
First Line	:	1030 MULBERRY AVE
Second Line	:
City	:	SELMER
State	:	TN
Zip	:	38375-6629
Country	:	US
Telephone Number	:	731-646-0021
Fax Number	:	731-434-0382

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	03/12/2026

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