Provider Demographics
NPI:1306868823
Name:MCLOUGHLIN, JOHN T (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:MCLOUGHLIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 BAY SHORE RD
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-5325
Mailing Address - Country:US
Mailing Address - Phone:631-665-6814
Mailing Address - Fax:631-969-7911
Practice Address - Street 1:245 BAY SHORE RD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-5325
Practice Address - Country:US
Practice Address - Phone:631-665-6814
Practice Address - Fax:631-969-7911
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0424871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice