Provider Demographics
NPI:1578685012
Name:MCCARTHY, DECLAN PETER (DDS)
Entity Type:Individual
Prefix:DR
First Name:DECLAN
Middle Name:PETER
Last Name:MCCARTHY
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 1:498 HILLSIDE AVE
Mailing Address - Street 2:SUITE 2W
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-4546
Mailing Address - Country:US
Mailing Address - Phone:630-469-2200
Mailing Address - Fax:
Practice Address - Street 1:498 HILLSIDE AVE
Practice Address - Street 2:SUITE 2W
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-4546
Practice Address - Country:US
Practice Address - Phone:630-469-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice