Basic Information
| Provider Information | |||||||||
| NPI: | 1861473332 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCLEAN | ||||||||
| FirstName: | DALE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4755 NC HWY 9 SOUTH | ||||||||
| Address2: | |||||||||
| City: | TRYON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286924289 | ||||||||
| FaxNumber: | 8286924396 | ||||||||
| Practice Location | |||||||||
| Address1: | 2595 CHIMNEY ROCK RD | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287929181 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286924289 | ||||||||
| FaxNumber: | 8286924396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 7721 | NC | X | Dental Providers | Dentist | 1223D0001X | 7721 | NC | X | Dental Providers | Dentist | Dental Public Health | 1223G0001X | 7721 | NC | X | Dental Providers | Dentist | General Practice | 1223P0221X | 7721 | NC | X | Dental Providers | Dentist | Pediatric Dentistry |
ID Information
| ID | Type | State | Issuer | Description | 89902PT | 05 | NC | MEDICAID | 0147G | 01 | NC | BCBS | OTHER | 344556D | 05 | NC | MEDICAID |