Provider Demographics
NPI:1447680533
Name:MCGILVRAY, JOHN M (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:MCGILVRAY
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 1:6029 N 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8200
Mailing Address - Country:US
Mailing Address - Phone:850-476-5034
Mailing Address - Fax:
Practice Address - Street 1:6029 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8200
Practice Address - Country:US
Practice Address - Phone:850-476-5034
Practice Address - Fax:850-476-5036
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15843122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist