Provider Demographics
NPI:1417397241
Name:MCDONOUGH, KATHRYN FAYE (DMD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:FAYE
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 1:114 TIMBER OAK CT
Mailing Address - Street 2:
Mailing Address - City:VENETIA
Mailing Address - State:PA
Mailing Address - Zip Code:15367-2312
Mailing Address - Country:US
Mailing Address - Phone:412-418-3378
Mailing Address - Fax:
Practice Address - Street 1:393 VANADIUM RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15243-1427
Practice Address - Country:US
Practice Address - Phone:412-429-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2014-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039592122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist