Individual
DR. MATTHEW MCLELLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1100 S PONCE DE LEON BLVD STE 2, ST AUGUSTINE, FL 32084-6013
(904) 829-6321
(904) 829-2338
Mailing address
1100 S PONCE DE LEON BLVD STE 2, ST AUGUSTINE, FL 32084-6013
(904) 829-6321
(904) 829-2338
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN11125
FL
Other
Enumeration date
07/09/2006
Last updated
07/08/2007
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