Mclellan Dental Inc.

NPI #1790920544 in St Augustine, Florida

Provider Information

NPI Number: 1790920544
Entity Type: Organization
Organization Name: Mclellan Dental Inc.
Primary Specialty: Dentist
Enumeration Date: Dec 9, 2008
Last Updated: Dec 9, 2008

Practice Location

Address: 1100 S PONCE DE LEON BLVD STE 2
City: St Augustine
State: Florida
ZIP Code: 32084-6013
Phone: (904) 829-6321

Authorized Official

Name: DR. MATTHEW MCLELLAN, D.M.D.
Title: OWNER
Phone: (904) 829-6321

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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