Provider Demographics
NPI:1306829643
Name:MCDONOUGH, CHERYL EILEEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:EILEEN
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 VIA PICO PLZ
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-3998
Mailing Address - Country:US
Mailing Address - Phone:949-492-0042
Mailing Address - Fax:949-492-0047
Practice Address - Street 1:67 VIA PICO PLZ
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-3998
Practice Address - Country:US
Practice Address - Phone:949-492-0042
Practice Address - Fax:949-492-0047
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA449391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice