Provider Demographics
NPI:1083095558
Name:MCLAREN, MARK (DDS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MCLAREN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 E DOUGLAS AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3957
Mailing Address - Country:US
Mailing Address - Phone:316-263-2444
Mailing Address - Fax:405-737-8872
Practice Address - Street 1:4620 E DOUGLAS AVE STE 102
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3957
Practice Address - Country:US
Practice Address - Phone:316-263-2444
Practice Address - Fax:405-737-8872
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist