Provider Demographics
NPI:1609155217
Name:MCNAIR FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:MCNAIR FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GRAND POOBAH
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCNAIR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-703-5344
Mailing Address - Street 1:125 E 3RD ST STE A
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-3822
Mailing Address - Country:US
Mailing Address - Phone:405-703-5344
Mailing Address - Fax:405-703-5343
Practice Address - Street 1:125 E 3RD ST STE A
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-3822
Practice Address - Country:US
Practice Address - Phone:405-703-5344
Practice Address - Fax:405-703-5343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK60561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty