Provider Demographics
NPI:1568520377
Name:MCMAHON, JOHN F (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:MCMAHON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2076 BALDWIN ST
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-8772
Mailing Address - Country:US
Mailing Address - Phone:616-457-2710
Mailing Address - Fax:616-457-5992
Practice Address - Street 1:2076 BALDWIN ST
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-8772
Practice Address - Country:US
Practice Address - Phone:616-457-2710
Practice Address - Fax:616-457-5992
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010133051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice