Provider Demographics
NPI:1700301991
Name:MCCAUGHEY, MARK PATRICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:PATRICK
Last Name:MCCAUGHEY
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 1:6229 DUCK KEY CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-2541
Mailing Address - Country:US
Mailing Address - Phone:515-250-0620
Mailing Address - Fax:
Practice Address - Street 1:2750 STICKNEY POINT RD STE 109
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-6023
Practice Address - Country:US
Practice Address - Phone:515-250-0620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-08
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22953122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist