Individual
ETHAN PATRICK MCLEOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
827 11TH AVE, NEW YORK, NY 10019-3535
(212) 369-5566
Mailing address
602 WILD BIRD LN, SAINT AUGUSTINE, FL 32080-6113
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
063502
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/20/2022
Last updated
06/27/2024
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