Provider Demographics
NPI:1003932401
Name:MCDONOUGH, JAMES MARTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MARTIN
Last Name:MCDONOUGH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:WOLLASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02170-2004
Mailing Address - Country:US
Mailing Address - Phone:617-479-8375
Mailing Address - Fax:617-479-8390
Practice Address - Street 1:628 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:WOLLASTON
Practice Address - State:MA
Practice Address - Zip Code:02170-2004
Practice Address - Country:US
Practice Address - Phone:617-479-8375
Practice Address - Fax:617-479-8390
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA123621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice