Healthcare Provider Details

I. General information

NPI: 1356606461
Provider Name (Legal Business Name): MCLAIN SURGICAL ARTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2012
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 TaxonomyN
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number5212
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number28817
License Number StateAL

VIII. Authorized Official

Name: LANDON MCLAIN
Title or Position: SURGEON
Credential: MD, DMD
Phone: 256-429-3411