MEDICARE: DR. LAWRENCE PATRICK MCDONOUGH D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	22DIO1593900	NJ

General Provider Information

NPI Number	:	1881850675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE PATRICK MCDONOUGH D.D.S.

Provider Business Mailing Address
First Line	:	806 FARNSWORTH AVE
Second Line	:
City	:	BORDENTOWN
State	:	NJ
Zip	:	08505-2104
Country	:	US
Telephone Number	:	609-298-8309
Fax Number	:	609-298-7002

Provider Business Practice Location Address
First Line	:	806 FARNSWORTH AVE
Second Line	:
City	:	BORDENTOWN
State	:	NJ
Zip	:	08505-2104
Country	:	US
Telephone Number	:	609-298-8309
Fax Number	:	609-298-7002

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2008
Last Update Date	:	08/01/2008

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