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General NPI Number Information
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NPI Number | 1245320449
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Entity Type | Organization
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Legal Business Name | MARK L. MCCLENDON, PA
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1020 N MILLS AVE
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City | ARCADIA
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State | FL
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Zip | 34266-8811
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Country | US
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Telephone | 863-494-6116
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Fax | 863-494-2660
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Provider Business Mailing Address
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Address Line | 1020 N MILLS AVE
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City | ARCADIA
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State | FL
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Zip | 34266-8811
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Country | US
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Telephone | 863-494-6116
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Fax | 863-494-2660
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. MARK LESTER MCCLENDON
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Credential | D.D.S.
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Telephone | 863-494-6116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN0011846
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License Number State | FL
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