Provider Demographics
NPI:1528599305
Name:MCANINCH DENTAL GROUP, INC.
Entity Type:Organization
Organization Name:MCANINCH DENTAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:MCANINCH
Authorized Official - Suffix:IV
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-735-3665
Mailing Address - Street 1:1111 EAST OCEAN AVENUE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436
Mailing Address - Country:US
Mailing Address - Phone:805-735-3665
Mailing Address - Fax:805-735-5665
Practice Address - Street 1:1111 EAST OCEAN AVENUE
Practice Address - Street 2:SUITE 9
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436
Practice Address - Country:US
Practice Address - Phone:805-735-3665
Practice Address - Fax:805-735-5665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA622041223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty