Healthcare Provider Details

I. General information

NPI: 1366433948
Provider Name (Legal Business Name): MICHAEL JOHN MCLAUGHLIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 CHEMAWA RD NE CHEMAWA INDIAN HEALTH CENTER
SALEM OR
97305-1119
US

IV. Provider business mailing address

3750 CHEMAWA RD NE CHEMAWA INDIAN HEALTH CENTER
SALEM OR
97305-1119
US

V. Phone/Fax

Practice location:
  • Phone: 503-304-7631
  • Fax: 503-304-7679
Mailing address:
  • Phone: 503-304-7631
  • Fax: 503-304-7679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019 024419
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: