Organization
MCLEAN DENTAL CLINIC, P.C.
Active
Parent organization
MCLEAN DENTAL, P.C.
Organization subpart
Yes
Provider details
NPI number
Legal business name
MCLEAN DENTAL, P.C.
Authorized official
DR. MUMTAZ SIDDIQUE (DOCTOR)
(815) 943-7709
Entity
Organization
Contact information
Practice address
400 N DIVISION ST, HARVARD, IL 60033-3061
(815) 943-7709
(815) 943-2009
Mailing address
400 N DIVISION ST, HARVARD, IL 60033-3061
(815) 943-7709
(815) 943-2009
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019022632
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019022632
—
IL
Enumeration date
05/04/2015
Last updated
05/04/2015
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