Provider Demographics
NPI:1336748896
Name:MACDOUGALL, CYNTHIA GARCIA
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:GARCIA
Last Name:MACDOUGALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:GARCIA
Other - Last Name:MACDOUGALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDHAP, BS
Mailing Address - Street 1:444 HERMOSA AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-4433
Mailing Address - Country:US
Mailing Address - Phone:310-376-9001
Mailing Address - Fax:
Practice Address - Street 1:444 HERMOSA AVE APT 302
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-4433
Practice Address - Country:US
Practice Address - Phone:310-376-9001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-25
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23320124Q00000X
CA805124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist