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General NPI Number Information
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NPI Number | 1609155217
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Entity Type | Organization
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Legal Business Name | MCNAIR FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 08/12/2011
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Last Update Date | 08/12/2011
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Provider Practice Location Address
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Address Line | 125 E 3RD ST STE A
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City | EDMOND
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State | OK
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Zip | 73034-3822
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Country | US
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Telephone | 405-703-5344
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Fax | 405-703-5343
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Provider Business Mailing Address
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Address Line | 125 E 3RD ST STE A
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City | EDMOND
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State | OK
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Zip | 73034-3822
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Country | US
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Telephone | 405-703-5344
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Fax | 405-703-5343
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Authorized Official
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Title or Position | GRAND POOBAH
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Name | DANIEL S MCNAIR
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Credential | DDS
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Telephone | 405-703-5344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6056
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License Number State | OK
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