MEDICARE: DR. GREGORY THOMAS MCMAHON D.D.S.

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	043245	NY

General Provider Information

NPI Number	:	1942269709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY THOMAS MCMAHON D.D.S.

Provider Business Mailing Address
First Line	:	2711 ALBANY POST RD
Second Line	:
City	:	MONTGOMERY
State	:	NY
Zip	:	12549-2158
Country	:	US
Telephone Number	:	845-457-1647
Fax Number	:	845-818-3921

Provider Business Practice Location Address
First Line	:	2711 ALBANY POST RD
Second Line	:
City	:	MONTGOMERY
State	:	NY
Zip	:	12549-2158
Country	:	US
Telephone Number	:	845-457-1647
Fax Number	:	845-818-3921

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	01/22/2015

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