Provider Demographics
NPI:1114038247
Name:MCGANN, PATRICK J (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:MCGANN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1309
Mailing Address - Street 2:MAIL CODE 21113A
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-1309
Mailing Address - Country:US
Mailing Address - Phone:952-883-5151
Mailing Address - Fax:952-883-5160
Practice Address - Street 1:5901 JOHN MARTIN DR
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430
Practice Address - Country:US
Practice Address - Phone:763-566-3770
Practice Address - Fax:763-569-1404
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-05-11
Deactivation Date:2023-04-11
Deactivation Code:
Reactivation Date:2023-05-11
Provider Licenses
StateLicense IDTaxonomies
MN116891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN978111100Medicaid