MEDICARE: MARK A MCCALL 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	14785	TX

General Provider Information

NPI Number	:	1255354882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK A MCCALL DDS

Provider Business Mailing Address
First Line	:	2229 COLUMBUS AVE
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76701-1038
Country	:	US
Telephone Number	:	254-753-3634
Fax Number	:	254-753-1799

Provider Business Practice Location Address
First Line	:	2229 COLUMBUS AVE
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76701-1038
Country	:	US
Telephone Number	:	254-753-3634
Fax Number	:	254-753-1799

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/08/2007

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