Provider Demographics
NPI:1902943772
Name:MACAULAY, JOHN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:MACAULAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:400 N BUCKSTOWN RD
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-8310
Mailing Address - Country:US
Mailing Address - Phone:215-750-1717
Mailing Address - Fax:215-750-6109
Practice Address - Street 1:400 N BUCKSTOWN RD
Practice Address - Street 2:SUITE 1C
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-8310
Practice Address - Country:US
Practice Address - Phone:215-750-1717
Practice Address - Fax:215-750-6109
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADSO17051L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry