Provider Demographics
NPI:1689683898
Name:MCDONOUGH, ERIC MATTHEW (DMD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:MATTHEW
Last Name:MCDONOUGH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 WEST CHESTNUT ST.
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301
Mailing Address - Country:US
Mailing Address - Phone:724-228-6684
Mailing Address - Fax:724-228-8606
Practice Address - Street 1:2031 WEST CHESTNUT ST.
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301
Practice Address - Country:US
Practice Address - Phone:724-228-6684
Practice Address - Fax:724-228-8606
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030565L1223G0001X
PADS-030565-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice