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General NPI Number Information
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NPI Number | 1619424611
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Entity Type | Organization
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Legal Business Name | BRYAN W. MCLELLAND, D.D.S., P.S.
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Dates
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Enumeration Date | 09/07/2016
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Last Update Date | 09/07/2016
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Provider Practice Location Address
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Address Line | 602 N CALGARY CT SUITE 202
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City | POST FALLS
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State | ID
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Zip | 83854-4000
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Country | US
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Telephone | 208-262-2660
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Fax | 509-344-1113
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Provider Business Mailing Address
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Address Line | 602 N CALGARY CT SUITE 202
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City | POST FALLS
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State | ID
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Zip | 83854-4000
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Country | US
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Telephone | 208-262-2660
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Fax | 509-344-1113
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Authorized Official
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Title or Position | OWNER / ORAL SURGEON
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Name | DR. BRYAN MCLELLAND
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Credential | DDS
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Telephone | 509-939-7684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number |
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License Number State |
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