Provider Demographics
NPI:1124245014
Name:MCCAFFERY, HAROLD MALCOLM (DDS)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:MALCOLM
Last Name:MCCAFFERY
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 1:433 HOLLYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-2660
Mailing Address - Country:US
Mailing Address - Phone:734-242-6645
Mailing Address - Fax:
Practice Address - Street 1:1262 N MACOMB ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3197
Practice Address - Country:US
Practice Address - Phone:724-241-6166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI085991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice