Provider Demographics
NPI:1508084500
Name:MCDOUGAL, TOM MAC (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:MAC
Last Name:MCDOUGAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:106 N COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-4701
Mailing Address - Country:US
Mailing Address - Phone:972-231-5376
Mailing Address - Fax:972-231-6074
Practice Address - Street 1:106 N COTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4701
Practice Address - Country:US
Practice Address - Phone:972-231-5376
Practice Address - Fax:972-231-6074
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice