Provider Demographics
NPI:1841307501
Name:MCGAUGHEY, JOHN WARREN (DDS)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WARREN
Last Name:MCGAUGHEY
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 1:326 N MT SHASTA BLVD
Mailing Address - Street 2:#4
Mailing Address - City:MT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067
Mailing Address - Country:US
Mailing Address - Phone:530-926-6441
Mailing Address - Fax:530-926-6441
Practice Address - Street 1:326 N MT SHASTA BLVD
Practice Address - Street 2:#4
Practice Address - City:MT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067
Practice Address - Country:US
Practice Address - Phone:530-926-6441
Practice Address - Fax:530-926-6441
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20231122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB2023101OtherDENTICAL