Provider Demographics
NPI:1801148903
Name:MCCANN, MAUREEN PATRICIA (RDH,BSDH)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:PATRICIA
Last Name:MCCANN
Suffix:
Gender:F
Credentials:RDH,BSDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 N POPE ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:VA
Mailing Address - Zip Code:22812-1424
Mailing Address - Country:US
Mailing Address - Phone:540-246-5991
Mailing Address - Fax:
Practice Address - Street 1:309 N POPE ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:VA
Practice Address - Zip Code:22812-1424
Practice Address - Country:US
Practice Address - Phone:540-246-5991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402002105124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist