Healthcare Provider Details

I. General information

NPI: 1275524316
Provider Name (Legal Business Name): TERRENCE R MCLEAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 GRIDER ST
BUFFALO NY
14215-3021
US

IV. Provider business mailing address

462 GRIDER ST
BUFFALO NY
14215-3021
US

V. Phone/Fax

Practice location:
  • Phone: 716-898-3537
  • Fax: 716-898-3716
Mailing address:
  • Phone: 716-898-3537
  • Fax: 716-898-3716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number038570-0
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: