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General NPI Number Information
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NPI Number | 1245433143
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Entity Type | Organization
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Legal Business Name | MCNAMARA FAMILY DENTISTRY
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 13997 W HIGHWAY 53
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City | RATHDRUM
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State | ID
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Zip | 83858-8594
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Country | US
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Telephone | 208-687-0688
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Fax | 208-687-0447
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Provider Business Mailing Address
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Address Line | 13997 W HIGHWAY 53
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City | RATHDRUM
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State | ID
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Zip | 83858
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Country | US
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Telephone | 208-687-0688
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Fax | 208-687-0447
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Authorized Official
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Title or Position | PRESIDENT OF CORPORATION
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Name | DR. JAMES M MCNAMARA
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Credential | DDS
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Telephone | 208-687-0688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D1605
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License Number State | ID
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