Provider Demographics
NPI:1952480626
Name:MCCANN, BRIGID ETHEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIGID
Middle Name:ETHEL
Last Name:MCCANN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:BRIGID
Other - Middle Name:ETHEL
Other - Last Name:FITCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504-0155
Mailing Address - Country:US
Mailing Address - Phone:928-729-5736
Mailing Address - Fax:
Practice Address - Street 1:FORT DEFIANCE PHS HOSPITAL
Practice Address - Street 2:CORNER OF RT N12 N7
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:928-729-8885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY53002122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ126970Medicaid
NM95373861Medicaid