Provider Demographics
NPI:1790769925
Name:MCNALLY, STUART J (DDS)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:J
Last Name:MCNALLY
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 1:3932 S 24TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-1849
Mailing Address - Country:US
Mailing Address - Phone:402-733-3932
Mailing Address - Fax:402-733-1933
Practice Address - Street 1:3932 S 24TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-1849
Practice Address - Country:US
Practice Address - Phone:402-733-3932
Practice Address - Fax:402-733-1933
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE65601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47071268419Medicaid
NE47071268413Medicaid
NE1744724OtherUNITED CONCORDIA ID
NE5404OtherBCBS PROVIDER ID