Healthcare Provider Details

I. General information

NPI: 1245320449
Provider Name (Legal Business Name): MARK L. MCCLENDON, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 N MILLS AVE
ARCADIA FL
34266-8811
US

IV. Provider business mailing address

1020 N MILLS AVE
ARCADIA FL
34266-8811
US

V. Phone/Fax

Practice location:
  • Phone: 863-494-6116
  • Fax: 863-494-2660
Mailing address:
  • Phone: 863-494-6116
  • Fax: 863-494-2660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN0011846
License Number StateFL

VIII. Authorized Official

Name: DR. MARK LESTER MCCLENDON
Title or Position: PRESIDENT/OWNER
Credential: D.D.S.
Phone: 863-494-6116