Provider Demographics
NPI:1477030435
Name:MCNAUGHTON, BEVERLY MOUSSEAU (RDH)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:MOUSSEAU
Last Name:MCNAUGHTON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 MAJESTIC CT
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5723
Mailing Address - Country:US
Mailing Address - Phone:248-933-3543
Mailing Address - Fax:
Practice Address - Street 1:2840 MAJESTIC CT
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-5723
Practice Address - Country:US
Practice Address - Phone:248-933-3543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902004138124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist