Provider Demographics
NPI:1063412302
Name:MCMAHAN, JAMES G (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:MCMAHAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-1906
Mailing Address - Country:US
Mailing Address - Phone:541-963-5632
Mailing Address - Fax:541-963-4584
Practice Address - Street 1:504 4TH ST
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-1906
Practice Address - Country:US
Practice Address - Phone:541-963-5632
Practice Address - Fax:541-963-4584
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR59741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice