Provider Demographics
NPI:1396125415
Name:DAWN MCCLELLAN, DDS, MS, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:DAWN MCCLELLAN, DDS, MS, A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:MCCLELLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:702-499-8798
Mailing Address - Street 1:5429 PAINTED SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-6447
Mailing Address - Country:US
Mailing Address - Phone:702-499-8798
Mailing Address - Fax:702-998-0675
Practice Address - Street 1:3603 LAS VEGAS BLVD N STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-0591
Practice Address - Country:US
Practice Address - Phone:702-499-8798
Practice Address - Fax:702-998-0675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS6-231223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty