Provider Demographics
NPI:1447377528
Name:MCCLOUD, LEROY (DDS)
Entity type:Individual
Prefix:DR
First Name:LEROY
Middle Name:
Last Name:MCCLOUD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-1008
Mailing Address - Country:US
Mailing Address - Phone:727-327-5561
Mailing Address - Fax:727-327-5560
Practice Address - Street 1:484 AVILA CIR NE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-3117
Practice Address - Country:US
Practice Address - Phone:727-526-2017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 58151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice