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General NPI Number Information
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NPI Number | 1841312303
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Entity Type | Individual
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Provider Name | MATT DALE MACLEAN D.M.D.,M.S.
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Gender | Male
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10234 CANOGA AVE
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City | CHATSWORTH
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State | CA
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Zip | 91311-3007
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Country | US
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Telephone | 818-341-5150
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Fax | 818-341-0123
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Provider Business Mailing Address
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Address Line | 789 HARTGLEN AVE
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-2069
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Country | US
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Telephone | 805-497-9811
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 38202
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License Number State | CA
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