Provider Demographics
NPI:1881850675
Name:MCDONOUGH, LAWRENCE PATRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:PATRICK
Last Name:MCDONOUGH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 FARNSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-2104
Mailing Address - Country:US
Mailing Address - Phone:609-298-8309
Mailing Address - Fax:609-298-7002
Practice Address - Street 1:806 FARNSWORTH AVE
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-2104
Practice Address - Country:US
Practice Address - Phone:609-298-8309
Practice Address - Fax:609-298-7002
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DIO1593900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist