Robert George McNab, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

9220 Issued in MN

Practice address

5346 Penn Ave S
Minneapolis, MN 55419-1065

Phone

(612) 922-0894

Fax

(612) 922-1352

NPI assigned

Sep 13, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 27, 2016 through Jul 27, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Penn Avenue Family Dental

  • General Practice Dentistry
  • Minneapolis, MN
  • NPI 1376648402
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1245335371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5346 PENN AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554191065",
            "telephone_number": "612-922-0894",
            "fax_number": "612-922-1352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5346 PENN AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554191065",
            "telephone_number": "612-922-0894",
            "fax_number": "612-922-1352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCNAB",
        "first_name": "ROBERT",
        "middle_name": "GEORGE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "9220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Rose McMonigal, OTR
• Carla D McMorris, RDH, BS
• Megan McMullen, RPH
• Dianne McMurray
• Roxanne McMurray, CRNA
• Jay Thomas McNamara, PHD
• Jennifer Lori McNamara, RN, CNP
• John J McNamara, M.D.
• Louise Marie McNamara, APRN
• Timothy C McNamara, MA, LP

• General Practice Dentistry in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.