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General NPI Number Information
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NPI Number | 1790909000
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Entity Type | Organization
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Legal Business Name | PAUL MICHAEL MCLEOD DDS, INC.
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 919 E JEFFERSON BLVD SUITE LL02
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City | SOUTH BEND
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State | IN
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Zip | 46617-3112
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Country | US
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Telephone | 574-233-7331
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Fax |
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Provider Business Mailing Address
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Address Line | 51427 MEGAN CT
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City | GRANGER
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State | IN
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Zip | 46530-7832
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Country | US
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Telephone | 574-277-3532
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL MICHAEL MCLEOD
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Credential | DDS
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Telephone | 574-233-7331
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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 | 12009809A
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License Number State | IN
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