Organization
SHAWNEE DENTAL, PLLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS E MCLEAN D.M.D. (OWNER)
(502) 774-2400
Entity
Organization
Contact information
Practice address
222 AMY AVE, LOUISVILLE, KY 40212-2522
(502) 774-2400
(502) 772-3456
Mailing address
222 AMY AVE, LOUISVILLE, KY 40212-2522
(502) 774-2400
(502) 772-3456
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
61901344
—
KY
Enumeration date
08/29/2007
Last updated
08/29/2007
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