Provider Demographics
NPI:1841587953
Name:MCLAUGHLIN, IAN POL FERGUS (DMD)
Entity Type:Individual
Prefix:DR
First Name:IAN POL
Middle Name:FERGUS
Last Name:MCLAUGHLIN
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 1:59 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-2016
Mailing Address - Country:US
Mailing Address - Phone:617-327-6443
Mailing Address - Fax:
Practice Address - Street 1:59 BEECH ST
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-2016
Practice Address - Country:US
Practice Address - Phone:617-327-6443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-09
Last Update Date:2011-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18557691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice