Healthcare Provider Details

I. General information

NPI: 1811171754
Provider Name (Legal Business Name): LANDON D. MCLAIN MD, DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 CECIL ASHBURN DR SE SUITE 101
HUNTSVILLE AL
35802-2563
US

IV. Provider business mailing address

2045 CECIL ASHBURN DR SE SUITE 101
HUNTSVILLE AL
35802-2563
US

V. Phone/Fax

Practice location:
  • Phone: 256-429-3411
  • Fax: 256-429-3413
Mailing address:
  • Phone: 256-429-3411
  • Fax: 256-429-3413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5212
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number2011-00192
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2011-00192
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD.28817
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: