Provider Demographics
NPI:1841499506
Name:MACNAUGHTON, JAMES R (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:MACNAUGHTON
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 1:71 WAUKEGAN ROAD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044
Mailing Address - Country:US
Mailing Address - Phone:847-234-5766
Mailing Address - Fax:847-234-0877
Practice Address - Street 1:71 WAUKEGAN ROAD
Practice Address - Street 2:SUITE 600
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044
Practice Address - Country:US
Practice Address - Phone:847-234-5766
Practice Address - Fax:847-234-0877
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190016825122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist