Healthcare Provider Details

I. General information

NPI: 1922094176
Provider Name (Legal Business Name): MARK LESTER MCCLENDON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: MARK L MCCLENDON PA

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 07/08/2007
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 Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN0011846
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: