Provider Demographics
NPI:1144423732
Name:DONOUGHE, LEROY T (DMD)
Entity Type:Individual
Prefix:
First Name:LEROY
Middle Name:T
Last Name:DONOUGHE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 E CURTIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823-2119
Mailing Address - Country:US
Mailing Address - Phone:814-355-1483
Mailing Address - Fax:
Practice Address - Street 1:140 W BISHOP ST
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-1927
Practice Address - Country:US
Practice Address - Phone:814-355-7731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS17584L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist