Provider Demographics
NPI:1528377819
Name:MCDONOUGH, AARON (DDS)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:
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 1:3100 BROOKS ST STE A
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-8321
Mailing Address - Country:US
Mailing Address - Phone:406-542-7572
Mailing Address - Fax:
Practice Address - Street 1:3100 BROOKS ST STE A
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8321
Practice Address - Country:US
Practice Address - Phone:065-427-5724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT60071223X0400X, 1223X0400X
UT9548493-99211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics