=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437956109
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCCLIMANS ORTHODONTICS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2025
-----------------------------------------------------
Last Update Date | 02/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 186 HEALTHWEST DR
-----------------------------------------------------
City | DOTHAN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36303-1996
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-678-0096
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 186 HEALTHWEST DR
-----------------------------------------------------
City | DOTHAN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36303-1996
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-678-0096
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LESLIE ALVIN MCCLIMANS III
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 334-678-0096
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------