Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 5884 | AZ |
NPI | 1083729883 |
---|---|
Provider Name | Dr. Jeanette Maclean |
First Address | Glendale, AZ 85308-7177 |
Second Address | Glendale, AZ 85308-7177 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 08/07/2007 |