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General NPI Number Information
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NPI Number | 1023471513
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Entity Type | Organization
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Legal Business Name | MEADOW DENTAL CENTER, P.C.
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Dates
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Enumeration Date | 04/01/2016
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Last Update Date | 04/01/2016
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Provider Practice Location Address
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Address Line | 1943 SMITH TOWNSHIP STATE ROAD 306
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City | SLOVAN
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State | PA
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Zip | 15078-1111
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Country | US
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Telephone | 724-947-5880
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Fax | 724-947-9660
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Provider Business Mailing Address
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Address Line | 1943 SMITH TOWNSHIP STATE ROAD P.O. BOX 306
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City | SLOVAN
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State | PA
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Zip | 15078-0000
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Country | US
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Telephone | 724-947-5880
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Fax | 724-947-9660
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Authorized Official
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Title or Position | OWNER
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Name | MR. ERIC MATTHEW MCDONOUGH
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Credential | D.M.D
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Telephone | 412-628-9721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS-030565-L
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License Number State | PA
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