Provider Demographics
NPI:1104994474
Name:MCLEOD, ERIC SCOTT (DDS)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:SCOTT
Last Name:MCLEOD
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 1:14452 CORTE MOREA
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-3812
Mailing Address - Country:US
Mailing Address - Phone:858-484-8210
Mailing Address - Fax:
Practice Address - Street 1:43000 MIDWAY AVE
Practice Address - Street 2:BLDG 595, MARINE CORPS RECRUIT DEPOT
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92140-5692
Practice Address - Country:US
Practice Address - Phone:619-524-4009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45841223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics