Provider Demographics
NPI:1891755682
Name:MCLEAN, RONALD G (DDS)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:G
Last Name:MCLEAN
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 1:3575 EASTCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-1608
Mailing Address - Country:US
Mailing Address - Phone:718-515-9010
Mailing Address - Fax:718-515-0067
Practice Address - Street 1:3575 EASTCHESTER RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-1608
Practice Address - Country:US
Practice Address - Phone:718-515-9010
Practice Address - Fax:718-515-0067
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0406301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01026306Medicaid