Provider Demographics
NPI:1891813002
Name:JAMES A. MCNULTY DDS, INC.
Entity Type:Organization
Organization Name:JAMES A. MCNULTY DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCNULTY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-282-2510
Mailing Address - Street 1:4642 OBERLIN AVE
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-3164
Mailing Address - Country:US
Mailing Address - Phone:440-282-2510
Mailing Address - Fax:440-282-2510
Practice Address - Street 1:4642 OBERLIN AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3164
Practice Address - Country:US
Practice Address - Phone:440-282-2510
Practice Address - Fax:440-282-2510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13940261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental