Provider Demographics
NPI:1255354882
Name:MCCALL, MARK A (DDS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:MCCALL
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 1:2229 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76701-1038
Mailing Address - Country:US
Mailing Address - Phone:254-753-3634
Mailing Address - Fax:254-753-1799
Practice Address - Street 1:2229 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76701-1038
Practice Address - Country:US
Practice Address - Phone:254-753-3634
Practice Address - Fax:254-753-1799
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX147851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice