Provider Demographics
NPI:1629109020
Name:MCGEHEE, JAMES DALE (DDS)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DALE
Last Name:MCGEHEE
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:PO BOX 178
Mailing Address - Street 2:123 MONDAMIN STREET
Mailing Address - City:MINOOKA
Mailing Address - State:IL
Mailing Address - Zip Code:60447
Mailing Address - Country:US
Mailing Address - Phone:815-467-4414
Mailing Address - Fax:815-467-8233
Practice Address - Street 1:123 MONDAMIN STREET
Practice Address - Street 2:
Practice Address - City:MINOOKA
Practice Address - State:IL
Practice Address - Zip Code:60447
Practice Address - Country:US
Practice Address - Phone:815-467-4414
Practice Address - Fax:815-467-8233
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice