Healthcare Provider Details

I. General information

NPI: 1467447433
Provider Name (Legal Business Name): BRYAN W MCLELLAND DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 N SULLIVAN RD STE 120
SPOKANE VALLEY WA
99037-8535
US

IV. Provider business mailing address

507 N SULLIVAN RD STE 120
SPOKANE VALLEY WA
99037-8535
US

V. Phone/Fax

Practice location:
  • Phone: 509-822-2774
  • Fax: 509-344-1113
Mailing address:
  • Phone: 509-822-2774
  • Fax: 509-344-1113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number9238
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: