Healthcare Provider Details

I. General information

NPI: 1669507497
Provider Name (Legal Business Name): GERALD F MCCANN D.D.S., M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9714 3RD AVE NE SUITE 203
SEATTLE WA
98115-2044
US

IV. Provider business mailing address

24 EVERGREEN LN
MERCER ISLAND WA
98040-3910
US

V. Phone/Fax

Practice location:
  • Phone: 206-525-1515
  • Fax: 206-524-1014
Mailing address:
  • Phone: 206-232-2999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number4517
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: