=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255977070
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCLANGHLIN DENTAL INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2019
-----------------------------------------------------
Last Update Date | 11/27/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 96 MAIN ST
-----------------------------------------------------
City | LEOMINSTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-534-5089
-----------------------------------------------------
Fax | 978-840-3351
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 96 MAIN ST
-----------------------------------------------------
City | LEOMINSTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-534-5089
-----------------------------------------------------
Fax | 978-840-3351
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | IAN POL F MCLANGHLIN
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 781-983-3960
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------