Provider Demographics
NPI:1134390248
Name:MCMAHAN, MICHAEL S (DMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:MCMAHAN
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 1:2420 VISTA WAY
Mailing Address - Street 2:STE 105
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6190
Mailing Address - Country:US
Mailing Address - Phone:760-435-1195
Mailing Address - Fax:760-435-1168
Practice Address - Street 1:2420 VISTA WAY
Practice Address - Street 2:STE 105
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6190
Practice Address - Country:US
Practice Address - Phone:760-435-1195
Practice Address - Fax:760-435-1168
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37872122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist