Healthcare Provider Details

I. General information

NPI: 1528377819
Provider Name (Legal Business Name): AARON MCDONOUGH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 BROOKS ST STE A
MISSOULA MT
59801-8321
US

IV. Provider business mailing address

3100 BROOKS ST STE A
MISSOULA MT
59801-8321
US

V. Phone/Fax

Practice location:
  • Phone: 65-427-5724
  • Fax:
Mailing address:
  • Phone: 406-542-7572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6007
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: