Provider Demographics
NPI:1114038247
Name:MCGANN, PATRICK JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JAMES
Last Name:MCGANN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8981 33RD ST. NORTH
Mailing Address - Street 2:
Mailing Address - City:LAKE ELMO
Mailing Address - State:MN
Mailing Address - Zip Code:55042
Mailing Address - Country:US
Mailing Address - Phone:651-777-1337
Mailing Address - Fax:651-748-0480
Practice Address - Street 1:8981 33RD ST. NORTH
Practice Address - Street 2:
Practice Address - City:LAKE ELMO
Practice Address - State:MN
Practice Address - Zip Code:55042
Practice Address - Country:US
Practice Address - Phone:651-777-1337
Practice Address - Fax:651-748-0480
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2024-06-04
Deactivation Date:2023-04-11
Deactivation Code:
Reactivation Date:2023-05-11
Provider Licenses
StateLicense IDTaxonomies
MN116891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN978111100Medicaid