Provider Demographics
NPI:1790979664
Name:MARK D. MEDAUGH, D.M.D., P.C.
Entity Type:Organization
Organization Name:MARK D. MEDAUGH, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MEDAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:413-323-4335
Mailing Address - Street 1:20 GEORGE HANNUM RD
Mailing Address - Street 2:PO BOX 1310
Mailing Address - City:BELCHERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01007-8915
Mailing Address - Country:US
Mailing Address - Phone:413-323-4335
Mailing Address - Fax:413-323-7253
Practice Address - Street 1:20 GEORGE HANNUM RD
Practice Address - Street 2:
Practice Address - City:BELCHERTOWN
Practice Address - State:MA
Practice Address - Zip Code:01007-8915
Practice Address - Country:US
Practice Address - Phone:413-323-4335
Practice Address - Fax:413-323-7253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty