Provider Demographics
NPI:1831492768
Name:STEVEN R MCKANE DDS PC
Entity Type:Organization
Organization Name:STEVEN R MCKANE DDS PC
Other - Org Name:DAMASCUS DENTAL OF MT AIRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:MCKANE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-829-6550
Mailing Address - Street 1:1311 S MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-5447
Mailing Address - Country:US
Mailing Address - Phone:301-829-6550
Mailing Address - Fax:301-829-3674
Practice Address - Street 1:1311 S MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-5447
Practice Address - Country:US
Practice Address - Phone:301-829-6550
Practice Address - Fax:301-829-3674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD097241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty