Individual provider Active NPI

Holly Mabel McLean, DDS

  • Dentist
  • Saint Clair Shores, MI
National Provider Identifier
1487440731
Registry record updated May 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2901602624 Issued in MI
Practice address
30207 Harper Ave
Saint Clair Shores, MI 48082-2612
Phone
(248) 766-6097
NPI assigned
Apr 15, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 26, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 2901602624 MI Primary

Addresses

Primary practice location

30207 Harper Ave
Saint Clair Shores, MI 48082-2612

Mailing address

28029 Elmdale St
Saint Clair Shores, MI 48081-1416
Phone (248) 766-6097

Other practice location 1

2700 Martin Luther King Jr Blvd
Detroit, MI 48208-2576
Phone (313) 494-6873

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250625002171 MI Order and Referring Only - DentistPractitioner - Dentist 7517479538

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2901602624MIMDDentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1744675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779753600000",
    "number": "1487440731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28029 ELMDALE ST",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480811416",
            "telephone_number": "248-766-6097",
            "fax_number": "313-494-6834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30207 HARPER AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480822612",
            "telephone_number": "248-766-6097"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2700 Martin Luther King Jr Blvd",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482082576",
            "country_code": "US",
            "telephone_number": "313-494-6873",
            "fax_number": "313-494-6834",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCLEAN",
        "first_name": "HOLLY",
        "middle_name": "MABEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-04-15",
        "last_updated": "2026-05-26",
        "certification_date": "2026-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901602624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

Verify at the official NPI Registry.