Provider Demographics
NPI:1235499443
Name:MCLAUGHLIN DENTIST LLC
Entity Type:Organization
Organization Name:MCLAUGHLIN DENTIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN POL
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-983-3960
Mailing Address - Street 1:59 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-2016
Mailing Address - Country:US
Mailing Address - Phone:781-983-3960
Mailing Address - Fax:
Practice Address - Street 1:96 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-5539
Practice Address - Country:US
Practice Address - Phone:978-534-5089
Practice Address - Fax:978-389-0278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1223G0001X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty