Provider Demographics
NPI:1235649690
Name:MAC DENTAL CORPORATION
Entity Type:Organization
Organization Name:MAC DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:MAC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:240-383-7623
Mailing Address - Street 1:8534 HOPSEED LANE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129
Mailing Address - Country:US
Mailing Address - Phone:240-383-7623
Mailing Address - Fax:
Practice Address - Street 1:9855 ERMA ROAD, #110
Practice Address - Street 2:SCRIPPS PERIODONTICS
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131
Practice Address - Country:US
Practice Address - Phone:240-383-7623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAC DENTAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-11
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45585204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty