Provider Demographics
NPI:1649296187
Name:GAUGHAN, DAVID F (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:F
Last Name:GAUGHAN
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 1:1441 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2236
Mailing Address - Country:US
Mailing Address - Phone:781-821-0141
Mailing Address - Fax:781-821-5630
Practice Address - Street 1:656 CHAPMAN ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2064
Practice Address - Country:US
Practice Address - Phone:781-821-0141
Practice Address - Fax:781-821-5630
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15283122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist