Provider Demographics
NPI:1215377031
Name:DAVID N MCAUSLAN DDS PC
Entity Type:Organization
Organization Name:DAVID N MCAUSLAN DDS PC
Other - Org Name:GENOA SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:N
Authorized Official - Last Name:MCAUSLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-784-5166
Mailing Address - Street 1:619 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:IL
Mailing Address - Zip Code:60135-1309
Mailing Address - Country:US
Mailing Address - Phone:815-784-5166
Mailing Address - Fax:815-784-5167
Practice Address - Street 1:619 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:IL
Practice Address - Zip Code:60135-1309
Practice Address - Country:US
Practice Address - Phone:815-784-5166
Practice Address - Fax:815-784-5167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019017239261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental