MEDICARE: DR. JAMES EDWARD MCLAIN D.D.S.

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
1	1223G0001X	General Practice Dentistry	DEN00201792	CO

General Provider Information

NPI Number	:	1861757247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES EDWARD MCLAIN D.D.S.

Provider Business Mailing Address
First Line	:	2121 DELGANY ST
Second Line	:	UNIT 1342
City	:	DENVER
State	:	CO
Zip	:	80202-1684
Country	:	US
Telephone Number	:	810-397-4917
Fax Number	:

Provider Business Practice Location Address
First Line	:	2466 S COLORADO BLVD
Second Line	:	SUITE 102
City	:	DENVER
State	:	CO
Zip	:	80222-5931
Country	:	US
Telephone Number	:	303-691-6983
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2012
Last Update Date	:	07/11/2012

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