Provider Demographics
NPI:1003447731
Name:MICHAEL MCLAUGHLIN DDS PC
Entity Type:Organization
Organization Name:MICHAEL MCLAUGHLIN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-607-7237
Mailing Address - Street 1:940 N SWITZER CANYON DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-4852
Mailing Address - Country:US
Mailing Address - Phone:928-779-4568
Mailing Address - Fax:928-773-7971
Practice Address - Street 1:940 N SWITZER CANYON DR STE 201
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4852
Practice Address - Country:US
Practice Address - Phone:928-779-4568
Practice Address - Fax:928-773-7971
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHAEL MCLAUGHLIN DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ090118Medicaid