MEDICARE: JAMES H MACDOWELL DDS INC

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1760164875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES H MACDOWELL DDS INC

Provider Business Mailing Address
First Line	:	PO BOX 269090
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73126-9090
Country	:	US
Telephone Number	:	877-667-7669
Fax Number	:

Provider Business Practice Location Address
First Line	:	11710 EL CAMINO REAL STE 150
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2245
Country	:	US
Telephone Number	:	858-788-9788
Fax Number	:	858-258-4896

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	KATIE TUNDER
Credential	:
Telephone Number	:	877-667-7669

Provider Enumeration Date	:	08/07/2023
Last Update Date	:	08/07/2023

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