Provider Demographics
NPI:1861511941
Name:NANCY MCHALE,DDS AND PAULA WILSON, DDS
Entity Type:Organization
Organization Name:NANCY MCHALE,DDS AND PAULA WILSON, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:MCHALE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-586-6114
Mailing Address - Street 1:24401 MUIRLANDS BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-3950
Mailing Address - Country:US
Mailing Address - Phone:949-586-6114
Mailing Address - Fax:
Practice Address - Street 1:24401 MUIRLANDS BLVD STE D
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-3950
Practice Address - Country:US
Practice Address - Phone:949-586-6114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty