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NPI Code Detail

MEDICARE: HC MCCLENDON DDS INC

MEDICARE: HC MCCLENDON DDS INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223X0400XOrthodontics and Dentofacial Orthopedics DentistryZ6478CA

General Provider Information

NPI Number : 1376635763
Entity Type Code : Organization
Provider Name (Legal Business Name) : HC MCCLENDON DDS INC
Provider Business Mailing Address
First Line : 5117 MARBURN AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90043-2143
Country : US
Telephone Number : 323-298-0109
Fax Number : 323-298-7011
Provider Business Practice Location Address
First Line : 5117 MARBURN AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90043-2143
Country : US
Telephone Number : 323-298-0109
Fax Number : 323-298-7011
Authorized Official
Title or Position : PRESIDENT OWNER
Name : DR. HAROLD CARVER MCCLENDON
Credential : DDS
Telephone Number : 323-298-0109
Provider Enumeration Date : 09/29/2006
Last Update Date : 04/05/2011

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