Individual
LYLE GRANT MCCLELLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
9717 N NEVADA ST, SPOKANE, WA 99218-3412
(509) 467-3315
Mailing address
6950 NE CAMPUS WAY, HILLSBORO, OR 97124-5611
(503) 952-2164
(503) 526-4418
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D3068
ID
122300000X
Dentist
D9557
OR
122300000X
Dentist
DE8382
WA
Other
Enumeration date
11/25/2006
Last updated
05/18/2015
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