Provider Demographics
NPI:1528126331
Name:MCCARL DENTAL GROUP PC
Entity type:Organization
Organization Name:MCCARL DENTAL GROUP PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCCARL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-987-8800
Mailing Address - Street 1:8601 VETERANS HIGHWAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108
Mailing Address - Country:US
Mailing Address - Phone:410-987-8800
Mailing Address - Fax:410-987-6969
Practice Address - Street 1:8601 VETERANS HIGHWAY
Practice Address - Street 2:SUITE 101
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108
Practice Address - Country:US
Practice Address - Phone:410-987-8800
Practice Address - Fax:410-987-6969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD8452122300000X
MD8476122300000X
MD10419122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty