Provider Demographics
NPI:1427592351
Name:MCNAMARA DDS PLLC
Entity Type:Organization
Organization Name:MCNAMARA DDS PLLC
Other - Org Name:MID-COLUMBIA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-513-0185
Mailing Address - Street 1:2620 S WILLIAMS PL
Mailing Address - Street 2:SUITE 120
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-1867
Mailing Address - Country:US
Mailing Address - Phone:509-591-0551
Mailing Address - Fax:
Practice Address - Street 1:2620 S WILLIAMS PL
Practice Address - Street 2:SUITE 120
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-1867
Practice Address - Country:US
Practice Address - Phone:509-591-0551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE605944161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1891108247OtherNPI INDIVIDUAL