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General NPI Number Information
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NPI Number | 1962524454
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Entity Type | Organization
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Legal Business Name | CHERYL E. MCDONOUGH, DMD, APC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 06/01/2010
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Provider Practice Location Address
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Address Line | 67 VIA PICO PLZ
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-3998
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Country | US
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Telephone | 949-492-0042
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Fax | 949-492-0047
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Provider Business Mailing Address
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Address Line | 67 VIA PICO PLZ
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-3998
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Country | US
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Telephone | 949-492-0042
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Fax | 949-492-0047
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHERYL EILEEN MCDONOUGH
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Credential | D.M.D.
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Telephone | 949-492-0042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 44939
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License Number State | CA
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