Provider Demographics
NPI:1679678973
Name:MCNAUGHT, DOUGLAS JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:JOHN
Last Name:MCNAUGHT
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:PO BOX 695
Mailing Address - Street 2:1870 W. WAYZATA BLVD.
Mailing Address - City:LONG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55356
Mailing Address - Country:US
Mailing Address - Phone:952-473-7151
Mailing Address - Fax:952-475-1539
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
Practice Address - Country:US
Practice Address - Phone:952-473-7151
Practice Address - Fax:952-475-1539
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN99851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice