Provider Demographics
NPI:1629153937
Name:MCLAURIN DMD PC, NANCY GAIL (DMD PC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:GAIL
Last Name:MCLAURIN DMD PC
Suffix:
Gender:F
Credentials:DMD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5555 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:SUITE G-73
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1703
Mailing Address - Country:US
Mailing Address - Phone:404-255-9511
Mailing Address - Fax:404-256-0901
Practice Address - Street 1:5555 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE G-73
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1703
Practice Address - Country:US
Practice Address - Phone:404-255-9511
Practice Address - Fax:404-256-0901
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0110111223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00558852BMedicaid