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NPI Code Detail

MEDICARE: DR. KEVIN T MCNALLY DDS

MEDICARE: DR. KEVIN T MCNALLY DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry27032CA

General Provider Information

NPI Number : 1063564706
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEVIN T MCNALLY DDS
Provider Business Mailing Address
First Line : 6804 S CENTINELA AVE
Second Line :
City : CULVER CITY
State : CA
Zip : 90230-6301
Country : US
Telephone Number : 310-915-0588
Fax Number : 310-915-0547
Provider Business Practice Location Address
First Line : 6804 S CENTINELA AVE
Second Line :
City : CULVER CITY
State : CA
Zip : 90230-6301
Country : US
Telephone Number : 310-915-0588
Fax Number : 310-915-0547
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2007
Last Update Date : 07/08/2007

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