Provider Demographics
NPI:1841521358
Name:MCCLAIN, MICHAEL PICKARD (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PICKARD
Last Name:MCCLAIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 E WOOD ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-5655
Mailing Address - Country:US
Mailing Address - Phone:731-644-9311
Mailing Address - Fax:731-644-9313
Practice Address - Street 1:1405 E WOOD ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-5655
Practice Address - Country:US
Practice Address - Phone:731-644-9311
Practice Address - Fax:731-644-9313
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43071223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0006647Medicaid