Healthcare Provider Details

I. General information

NPI: 1235499443
Provider Name (Legal Business Name): MCLAUGHLIN DENTIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 MAIN ST
LEOMINSTER MA
01453-5539
US

IV. Provider business mailing address

59 BEECH ST
WEST ROXBURY MA
02132-2016
US

V. Phone/Fax

Practice location:
  • Phone: 978-534-5089
  • Fax: 978-389-0278
Mailing address:
  • Phone: 781-983-3960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number StateMA

VIII. Authorized Official

Name: DR. IAN POL F MCLAUGHLIN
Title or Position: DENTIST
Credential: D.M.D.
Phone: 781-983-3960