Provider Demographics
NPI:1689055006
Name:BRIAN C. MCGUE DDS PC
Entity Type:Organization
Organization Name:BRIAN C. MCGUE DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCGUE
Authorized Official - Suffix:
Authorized Official - Credentials:DD,S,
Authorized Official - Phone:219-921-1999
Mailing Address - Street 1:700 S CALUMET RD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-3287
Mailing Address - Country:US
Mailing Address - Phone:219-921-1999
Mailing Address - Fax:
Practice Address - Street 1:700 S CALUMET RD
Practice Address - Street 2:SUITE #2
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-3287
Practice Address - Country:US
Practice Address - Phone:219-921-1999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009578261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental