Provider Demographics
NPI:1053585653
Name:DOUGLAS J MCNAUGHT D D S P A
Entity type:Organization
Organization Name:DOUGLAS J MCNAUGHT D D S P A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCNAUGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-473-7151
Mailing Address - Street 1:PO BOX 695
Mailing Address - Street 2:
Mailing Address - City:LONG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55356-0695
Mailing Address - Country:US
Mailing Address - Phone:952-473-7151
Mailing Address - Fax:
Practice Address - Street 1:1870 W WAYZATA BLVD
Practice Address - Street 2:
Practice Address - City:LONG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55356-9491
Practice Address - Country:US
Practice Address - Phone:952-473-7151
Practice Address - Fax:952-475-1539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND9985122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty