Provider Demographics
NPI:1336216878
Name:MCNAMARA, DONALD E (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:E
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 1:625 E BRISTOL ST
Mailing Address - Street 2:STE A
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-3476
Mailing Address - Country:US
Mailing Address - Phone:574-266-0090
Mailing Address - Fax:574-266-0236
Practice Address - Street 1:625 E BRISTOL ST
Practice Address - Street 2:STE A
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-3476
Practice Address - Country:US
Practice Address - Phone:574-266-0090
Practice Address - Fax:574-266-0236
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN82601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice