MEDICARE: DR. MARK XAVIER MCCARTHY DMD

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	13743	MO

General Provider Information

NPI Number	:	1811222060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK XAVIER MCCARTHY DMD

Provider Business Mailing Address
First Line	:	439 S KIRKWOOD RD
Second Line	:	SUITE 201
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-6169
Country	:	US
Telephone Number	:	314-822-3288
Fax Number	:	314-822-7279

Provider Business Practice Location Address
First Line	:	439 S KIRKWOOD RD
Second Line	:	SUITE 201
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-6169
Country	:	US
Telephone Number	:	314-822-3288
Fax Number	:	314-822-7279

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

Provider Enumeration Date	:	10/06/2009
Last Update Date	:	10/06/2009

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