Healthcare Provider Details

I. General information

NPI: 1598918278
Provider Name (Legal Business Name): ERIN E MCDONOUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N 7TH ST
ZANESVILLE OH
43701-3791
US

IV. Provider business mailing address

716 ADAIR AVE
ZANESVILLE OH
43701-2836
US

V. Phone/Fax

Practice location:
  • Phone: 740-454-9741
  • Fax:
Mailing address:
  • Phone: 740-454-5239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number31.012157
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: