Provider Demographics
NPI:1245335371
Name:MCNAB, ROBERT GEORGE (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GEORGE
Last Name:MCNAB
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 1:5346 PENN AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-1065
Mailing Address - Country:US
Mailing Address - Phone:612-922-0894
Mailing Address - Fax:612-922-1352
Practice Address - Street 1:5346 PENN AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55419-1065
Practice Address - Country:US
Practice Address - Phone:612-922-0894
Practice Address - Fax:612-922-1352
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN92201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice