MEDICARE: DR. JOHN R. MCDAVID 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
1	1223G0001X	General Practice Dentistry	3597	OK
2	1223D0001X	Public Health Dentistry	0016442	TX

General Provider Information

NPI Number	:	1194766188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN R. MCDAVID DDS

Provider Business Mailing Address
First Line	:	3919 N MACARTHUR BLVD
Second Line	:
City	:	WARR ACRES
State	:	OK
Zip	:	73122-2005
Country	:	US
Telephone Number	:	405-440-0113
Fax Number	:	405-470-1838

Provider Business Practice Location Address
First Line	:	3919 N MACARTHUR BLVD
Second Line	:
City	:	WARR ACRES
State	:	OK
Zip	:	73122-2005
Country	:	US
Telephone Number	:	405-440-0113
Fax Number	:	405-470-1838

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	01/12/2012

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