Provider Demographics
NPI:1336375039
Name:MCMAHON, JACLYN ANNETTE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:ANNETTE
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JACLYN
Other - Middle Name:ANNETTE
Other - Last Name:SLOVICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2241 W SCHAUMBURG RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-3891
Mailing Address - Country:US
Mailing Address - Phone:847-584-2241
Mailing Address - Fax:847-584-2241
Practice Address - Street 1:2241 W SCHAUMBURG RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-3891
Practice Address - Country:US
Practice Address - Phone:847-584-2241
Practice Address - Fax:847-584-2241
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027622122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist