Provider Demographics
NPI:1104285329
Name:MORROW COUNTY DENTAL, LESLIE MCDOUGALL,DDS,LLC
Entity type:Organization
Organization Name:MORROW COUNTY DENTAL, LESLIE MCDOUGALL,DDS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCDOUGALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-949-5007
Mailing Address - Street 1:527 C WEST MARION RD
Mailing Address - Street 2:
Mailing Address - City:MT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338
Mailing Address - Country:US
Mailing Address - Phone:419-949-5007
Mailing Address - Fax:419-464-9355
Practice Address - Street 1:527 W MARION RD STE C
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-1257
Practice Address - Country:US
Practice Address - Phone:419-949-5007
Practice Address - Fax:419-464-9355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment