Healthcare Provider Details

I. General information

NPI: 1487440731
Provider Name (Legal Business Name): HOLLY MABEL MCLEAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30207 HARPER AVE
SAINT CLAIR SHORES MI
48082-2612
US

IV. Provider business mailing address

28029 ELMDALE ST
SAINT CLAIR SHORES MI
48081-1416
US

V. Phone/Fax

Practice location:
  • Phone: 248-766-6097
  • Fax:
Mailing address:
  • Phone: 248-766-6097
  • Fax: 313-494-6834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901602624
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: