Provider Demographics
NPI: | 1306992029 |
---|---|
Name: | DAVID M MCGAFFIN DDS PA |
Entity type: | Organization |
Organization Name: | DAVID M MCGAFFIN DDS PA |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNERPRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | DAVID |
Authorized Official - Middle Name: | MICHAEL |
Authorized Official - Last Name: | MCGAFFIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 972-772-1808 |
Mailing Address - Street 1: | 5727 FM 3097(HORIZON RD.) |
Mailing Address - Street 2: | |
Mailing Address - City: | ROCKWALL |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75032-7786 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 972-772-1808 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 5727 FM 3097(HORIZON RD.) |
Practice Address - Street 2: | |
Practice Address - City: | ROCKWALL |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75032-7786 |
Practice Address - Country: | US |
Practice Address - Phone: | 972-772-1808 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-01-26 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 19722 | 1223G0001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223G0001X | Dental Providers | Dentist | General Practice | Group - Single Specialty |