Provider Demographics
NPI:1679549182
Name:MCDERMOTT, NANCY ELLEN (DMD MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ELLEN
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:DMD MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:605 W OAKLAND AVE
Mailing Address - Street 2:SEMOMS
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-2317
Mailing Address - Country:US
Mailing Address - Phone:507-433-1031
Mailing Address - Fax:507-433-6115
Practice Address - Street 1:605 W OAKLAND AVE
Practice Address - Street 2:SEMOMS
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-2317
Practice Address - Country:US
Practice Address - Phone:507-433-1031
Practice Address - Fax:507-433-6115
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2017-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNS1211223S0112X
MA8170207R00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery