Provider Demographics
NPI:1417086877
Name:MCAUSLAN, MARY KANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:KANE
Last Name:MCAUSLAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39W439 WOODGATE RD
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-7725
Mailing Address - Country:US
Mailing Address - Phone:630-584-1312
Mailing Address - Fax:630-584-3153
Practice Address - Street 1:1530 N RANDALL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-7877
Practice Address - Country:US
Practice Address - Phone:847-697-8844
Practice Address - Fax:847-697-8740
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice