Provider Demographics
NPI:1396840930
Name:MCCLINTOCK, STEVEN DOUGLAS (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DOUGLAS
Last Name:MCCLINTOCK
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 1:173 ROSCOE BLVD N
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3209
Mailing Address - Country:US
Mailing Address - Phone:904-343-6042
Mailing Address - Fax:
Practice Address - Street 1:STATE ROAD 121 SOUTH
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063
Practice Address - Country:US
Practice Address - Phone:904-259-6211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN99481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice