Provider Demographics
NPI:1982388336
Name:MCDONOUGH, ALLISON LEIGH (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:LEIGH
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 WENHAM ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4374
Mailing Address - Country:US
Mailing Address - Phone:732-841-5224
Mailing Address - Fax:
Practice Address - Street 1:793 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-2736
Practice Address - Country:US
Practice Address - Phone:617-522-1970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18598891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice