Provider Demographics
NPI:1215396692
Name:MCNAMARA, MARIANA ELENA (DMD)
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:ELENA
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MARIANA
Other - Middle Name:ELENA
Other - Last Name:ARANGUREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13395 N MARANA MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-7008
Mailing Address - Country:US
Mailing Address - Phone:520-682-4111
Mailing Address - Fax:520-818-3630
Practice Address - Street 1:13395 N MARANA MAIN ST
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85653-7008
Practice Address - Country:US
Practice Address - Phone:520-616-6200
Practice Address - Fax:520-682-1087
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0096311223G0001X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ245855Medicaid