Provider Demographics
NPI:1821486754
Name:MCDONNELL AND MCMAHON PEDIATRIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:MCDONNELL AND MCMAHON PEDIATRIC DENTISTRY PLLC
Other - Org Name:THE SMILE LODGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCDONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:518-373-1181
Mailing Address - Street 1:713 PIERCE RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-1302
Mailing Address - Country:US
Mailing Address - Phone:518-373-1181
Mailing Address - Fax:518-373-0130
Practice Address - Street 1:713 PIERCE RD
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-1302
Practice Address - Country:US
Practice Address - Phone:518-373-1181
Practice Address - Fax:518-373-0130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-30
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY488031223P0221X
NY0537341223P0221X
NY0547641223P0221X
NY0544771223P0221X
NY0567081223P0221X
NY0575551223P0221X
NY0576441223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty