Provider Demographics
NPI:1891108247
Name:MCNAMARA, TIM (DDS)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:MCNAMARA
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 1:2620 S WILLIAMS PL
Mailing Address - Street 2:120
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-1867
Mailing Address - Country:US
Mailing Address - Phone:405-513-0185
Mailing Address - Fax:
Practice Address - Street 1:2620 S WILLIAMS PL
Practice Address - Street 2:120
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-1867
Practice Address - Country:US
Practice Address - Phone:405-513-0185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2016-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60594416122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist