Provider Demographics
NPI:1326261900
Name:MCDONOUGH, KELLY FRANKLYN (DDS)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:FRANKLYN
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 1:19 MONARCH BAY PLZ
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3424
Mailing Address - Country:US
Mailing Address - Phone:949-487-7779
Mailing Address - Fax:
Practice Address - Street 1:19 MONARCH BAY PLZ
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3424
Practice Address - Country:US
Practice Address - Phone:949-487-7779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA331971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice