Provider Demographics
NPI:1700201381
Name:PAULINE J. MCDONOUGH D.D.S. L.L.C
Entity Type:Organization
Organization Name:PAULINE J. MCDONOUGH D.D.S. L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCDONOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:781-340-1200
Mailing Address - Street 1:1355 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-2720
Mailing Address - Country:US
Mailing Address - Phone:781-340-1200
Mailing Address - Fax:781-340-1204
Practice Address - Street 1:1355 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-2720
Practice Address - Country:US
Practice Address - Phone:781-340-1200
Practice Address - Fax:781-340-1204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20436122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty