Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | IL |
NPI | 1003968215 |
---|---|
Provider Name | Dr. John Mcnamara |
First Address | Naperville, IL 60565-2496 |
Second Address | Naperville, IL 60565-2496 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 08/07/2007 |