MEDICARE: MCGOUGH & MCGOUGH, P.C.

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	1223P0221X	Pediatric Dentistry	16926	TX
2	1223G0001X	General Practice Dentistry	16925	TX

General Provider Information

NPI Number	:	1225030455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCGOUGH & MCGOUGH, P.C.

Provider Business Mailing Address
First Line	:	2392 H G MOSLEY PKWY
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75604-3661
Country	:	US
Telephone Number	:	903-758-8770
Fax Number	:	903-758-3334

Provider Business Practice Location Address
First Line	:	2392 H G MOSLEY PKWY
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75604-3661
Country	:	US
Telephone Number	:	903-758-8770
Fax Number	:	903-758-3334

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHARLES MCGOUGH
Credential	:	D.D.S.
Telephone Number	:	903-758-8770

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	02/07/2008

Similar Medicare Providers

1669475620 — MR. JOEL THOMAS MUIRHEAD M. D.
Practice Location Address:

2394 H G MOSLEY PKWY
LONGVIEW, TX
75604-3661

Practice Phone: 903-539-9520
Practice Fax: 903-234-0775

1881761377 — DR. EMILY GREER MARSH OD
Practice Location Address:

2394 H G MOSLEY PKWY
LONGVIEW, TX
75604-3661

Practice Phone: 903-526-0444
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1134380421 — DR. KATHERINE RENEE MCGOUGH D.D.S.
Practice Location Address:

2392 H G MOSLEY PKWY
LONGVIEW, TX
75604-3661

Practice Phone: 903-758-8770
Practice Fax: 903-758-3334

1922269208 — DR. CHARLES THOMAS MCGOUGH D.D.S.
Practice Location Address:

2392 H G MOSLEY PKWY
LONGVIEW, TX
75604-3661

Practice Phone: 903-758-8770
Practice Fax: 903-758-3334

1942619275 — BLAKE THOMAS WILLIAMS O.D.
Practice Location Address:

2394 H G MOSLEY PKWY
LONGVIEW, TX
75604-3661

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Practice Fax: 903-234-0775

1326591728 — SHANNON LEBUS DO
Practice Location Address:

2394 H G MOSLEY PKWY
LONGVIEW, TX
75604-3661

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Practice Fax: 903-234-0775

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