Healthcare Provider Details

I. General information

NPI: 1942269709
Provider Name (Legal Business Name): GREGORY THOMAS MCMAHON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 ALBANY POST RD
MONTGOMERY NY
12549-2158
US

IV. Provider business mailing address

2711 ALBANY POST RD
MONTGOMERY NY
12549-2158
US

V. Phone/Fax

Practice location:
  • Phone: 845-457-1647
  • Fax: 845-818-3921
Mailing address:
  • Phone: 845-457-1647
  • Fax: 845-818-3921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number043245
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: