Provider Demographics
NPI:1467707828
Name:ANN MCDONOUGH, DMD, P.C.
Entity Type:Organization
Organization Name:ANN MCDONOUGH, DMD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCDONOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-693-1164
Mailing Address - Street 1:25 EAST 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:PA
Mailing Address - Zip Code:18644
Mailing Address - Country:US
Mailing Address - Phone:570-693-1164
Mailing Address - Fax:
Practice Address - Street 1:25 EAST 8TH STREET
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:PA
Practice Address - Zip Code:18644
Practice Address - Country:US
Practice Address - Phone:570-693-1164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0372881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty