MEDICARE: DR. KEVIN BYRON MCNALLY DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019035077	IL

General Provider Information

NPI Number	:	1881434611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN BYRON MCNALLY DMD

Provider Business Mailing Address
First Line	:	3212 FORSYTH DR
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-5520
Country	:	US
Telephone Number	:	708-341-8005
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 MANSION RD
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62711-6724
Country	:	US
Telephone Number	:	217-483-7177
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2024
Last Update Date	:	05/29/2024

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