Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 10723 | TX |
N | 1223E0200X | Endodontist | 10723 | TX |
Y | 1223G0001X | General Practice | 10723 | TX |
Y | 213EG0000X | General Practice | 10723 | TX |
N | 1223P0106X | Oral and Maxillofacial Pathology | 10723 | TX |
N | 1223P0221X | Pediatric Dentist | 10723 | TX |
N | 1223P0300X | Periodontist | 10723 | TX |
N | 1223P0700X | Prosthodontist | 10723 | TX |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 10723 | TX |
N | 1223X0008X | Oral and Maxillofacial Radiology | 10723 | TX |
N | 1223X0400X | Orthodontists | 10723 | TX |
NPI | 1245778869 |
---|---|
Provider Name | Dr. Michael Andrew Mccann |
First Address | Brazoria, TX 77422-1235 |
Second Address | Brazoria, TX 77422-8718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2017 |
Last Update Date | 02/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10723 | DENTAL LICENSE (01) | TX |