Provider Demographics
NPI:1053401505
Name:MCMAHAN, PHILIP SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:SCOTT
Last Name:MCMAHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:P
Other - Middle Name:SCOTT
Other - Last Name:MCMAHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1829 SUNSET CLIFFS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-3108
Mailing Address - Country:US
Mailing Address - Phone:619-223-1601
Mailing Address - Fax:619-223-7824
Practice Address - Street 1:1829 SUNSET CLIFFS BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-3108
Practice Address - Country:US
Practice Address - Phone:619-223-1601
Practice Address - Fax:619-223-7824
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADD0284741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice