Provider Demographics
NPI:1386052272
Name:MCANALLY, ERIC (DMD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:MCANALLY
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 1:29930 W DEERWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:GARDEN PLAIN
Mailing Address - State:KS
Mailing Address - Zip Code:67050-9241
Mailing Address - Country:US
Mailing Address - Phone:316-550-6020
Mailing Address - Fax:306-550-6039
Practice Address - Street 1:19931 W KELLOGG DR UNIT C
Practice Address - Street 2:
Practice Address - City:GODDARD
Practice Address - State:KS
Practice Address - Zip Code:67052-8864
Practice Address - Country:US
Practice Address - Phone:316-550-6020
Practice Address - Fax:316-550-6039
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61019122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist