Healthcare Provider Details

I. General information

NPI: 1215396692
Provider Name (Legal Business Name): MARIANA ELENA MCNAMARA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIANA ELENA ARANGUREN

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13395 N MARANA MAIN ST
MARANA AZ
85653-7008
US

IV. Provider business mailing address

13395 N MARANA MAIN ST
MARANA AZ
85653-7008
US

V. Phone/Fax

Practice location:
  • Phone: 520-616-6200
  • Fax: 520-682-1087
Mailing address:
  • Phone: 520-682-4111
  • Fax: 520-818-3630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD009631
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD009631
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: