Provider Demographics
NPI:1831320712
Name:MCGANNON, MICHAEL (DMD, MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MCGANNON
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 COLONIAL AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3450
Mailing Address - Country:US
Mailing Address - Phone:717-848-8822
Mailing Address - Fax:717-848-8116
Practice Address - Street 1:924 COLONIAL AVE
Practice Address - Street 2:SUITE H
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3450
Practice Address - Country:US
Practice Address - Phone:717-848-8822
Practice Address - Fax:717-848-8116
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0374931223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery