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General NPI Number Information
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NPI Number | 1396840930
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Entity Type | Individual
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Provider Name | STEVEN DOUGLAS MCCLINTOCK DDS
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Gender | Male
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | STATE ROAD 121 SOUTH
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City | MACCLENNY
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State | FL
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Zip | 32063
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Country | US
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Telephone | 904-259-6211
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Fax |
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Provider Business Mailing Address
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Address Line | 173 ROSCOE BLVD N
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32082-3209
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Country | US
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Telephone | 904-343-6042
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN9948
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License Number State | FL
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