Provider Demographics
NPI:1760834626
Name:MCCANN, KAITLIN (DMD)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:MCCANN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2223 GLOUCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4012
Mailing Address - Country:US
Mailing Address - Phone:216-903-3202
Mailing Address - Fax:
Practice Address - Street 1:9500 MENTOR AVE
Practice Address - Street 2:280
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-8713
Practice Address - Country:US
Practice Address - Phone:440-352-2887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-04
Last Update Date:2016-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.24755122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist