MEDICARE: DR. MEGHAN DIANNE MCDONOUGH DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	108561	CA

General Provider Information

NPI Number	:	1134902927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEGHAN DIANNE MCDONOUGH DDS

Provider Business Mailing Address
First Line	:	33821 CHULA VISTA AVE
Second Line	:
City	:	DANA POINT
State	:	CA
Zip	:	92629-2241
Country	:	US
Telephone Number	:	949-751-8029
Fax Number	:

Provider Business Practice Location Address
First Line	:	32932 PACIFIC COAST HWY STE 19
Second Line	:
City	:	DANA POINT
State	:	CA
Zip	:	92629-3467
Country	:	US
Telephone Number	:	949-487-7779
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2023
Last Update Date	:	08/15/2023

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