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General NPI Number Information
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NPI Number | 1750684478
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Entity Type | Organization
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Legal Business Name | KATHRYN C MCCLINTOCK DDS
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Dates
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Enumeration Date | 12/20/2010
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Last Update Date | 12/20/2010
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Provider Practice Location Address
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Address Line | 15215 GULF BLVD
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City | MADEIRA BEACH
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State | FL
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Zip | 33708-1814
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Country | US
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Telephone | 727-391-1963
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Fax | 727-393-9580
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Provider Business Mailing Address
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Address Line | 15215 GULF BLVD
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City | MADEIRA BEACH
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State | FL
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Zip | 33708-1814
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Country | US
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Telephone | 727-391-1963
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Fax | 727-393-9580
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Authorized Official
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Title or Position | OWNER
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Name | DR. KATHRYN CARREL MCCLINTOCK
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Credential | DDS
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Telephone | 727-391-1963
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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 | DN 8929
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License Number State | FL
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