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General NPI Number Information
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NPI Number | 1831692771
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Entity Type | Organization
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Legal Business Name | MCCARTY FAMILY DENTAL, LTD
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Dates
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Enumeration Date | 03/16/2018
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Last Update Date | 03/16/2018
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Provider Practice Location Address
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Address Line | 6737 KINGERY HWY
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City | WILLOWBROOK
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State | IL
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Zip | 60527-5142
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Country | US
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Telephone | 630-570-5555
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Fax | 630-570-5454
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Provider Business Mailing Address
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Address Line | 6737 KINGERY HWY
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City | WILLOWBROOK
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State | IL
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Zip | 60527-5142
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Country | US
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Telephone | 630-570-5555
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Fax | 630-570-5454
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Authorized Official
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Title or Position | PRESIDENT
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Name | SCOTT MCCARTY
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Credential | DDS
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Telephone | 630-570-5555
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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 | 019027938
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License Number State | IL
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