Provider Demographics
NPI:1356322531
Name:MACCARTHY, KILLIAN DAVID (DMD MD)
Entity Type:Individual
Prefix:DR
First Name:KILLIAN
Middle Name:DAVID
Last Name:MACCARTHY
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Gender:M
Credentials:DMD MD
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Mailing Address - Street 1:20 LONG CREEK DR
Mailing Address - Street 2:ORAL SURGERY ASSOCIATES PA
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2425
Mailing Address - Country:US
Mailing Address - Phone:207-772-3027
Mailing Address - Fax:207-772-3027
Practice Address - Street 1:20 LONG CREEK DR
Practice Address - Street 2:ORAL SURGERY ASSOCIATES PA
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2425
Practice Address - Country:US
Practice Address - Phone:207-772-3027
Practice Address - Fax:207-772-3027
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2015-05-29
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Provider Licenses
StateLicense IDTaxonomies
MEMD173481223S0112X
MA7105208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME000227002Medicare PIN