Provider Demographics
NPI:1801945191
Name:MCCANN, JUDITH ELAINE (DMD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ELAINE
Last Name:MCCANN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 BARKSDALE RD
Mailing Address - Street 2:101 BARKSDALE PROFESSIONAL CENTER
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-4535
Mailing Address - Country:US
Mailing Address - Phone:302-368-7463
Mailing Address - Fax:302-368-2520
Practice Address - Street 1:625 BARKSDALE RD
Practice Address - Street 2:101 BARKSDALE PROFESSIONAL CENTER
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-4535
Practice Address - Country:US
Practice Address - Phone:302-368-7463
Practice Address - Fax:302-368-2520
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEGI0000933122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000015397Medicaid