Provider Demographics
NPI:1326086455
Name:MCTIGUE, DENNIS JOHNSTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:JOHNSTON
Last Name:MCTIGUE
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 1:893 ANGUS CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2951
Mailing Address - Country:US
Mailing Address - Phone:614-431-0716
Mailing Address - Fax:
Practice Address - Street 1:305 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1267
Practice Address - Country:US
Practice Address - Phone:614-292-0898
Practice Address - Fax:614-292-1125
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-77221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810005182Medicaid
OH0571493Medicaid