Healthcare Provider Details

I. General information

NPI: 1376635763
Provider Name (Legal Business Name): HC MCCLENDON DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5117 MARBURN AVE
LOS ANGELES CA
90043-2143
US

IV. Provider business mailing address

5117 MARBURN AVE
LOS ANGELES CA
90043-2143
US

V. Phone/Fax

Practice location:
  • Phone: 323-298-0109
  • Fax: 323-298-7011
Mailing address:
  • Phone: 323-298-0109
  • Fax: 323-298-7011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberZ6478
License Number StateCA

VIII. Authorized Official

Name: DR. HAROLD CARVER MCCLENDON
Title or Position: PRESIDENT OWNER
Credential: DDS
Phone: 323-298-0109