Provider Demographics
NPI:1962524454
Name:CHERYL E. MCDONOUGH, DMD, APC
Entity type:Organization
Organization Name:CHERYL E. MCDONOUGH, DMD, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:MCDONOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:949-492-0042
Mailing Address - Street 1:67 VIA PICO PLZ
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-3998
Mailing Address - Country:US
Mailing Address - Phone:949-492-0042
Mailing Address - Fax:949-492-0047
Practice Address - Street 1:67 VIA PICO PLZ
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-3998
Practice Address - Country:US
Practice Address - Phone:949-492-0042
Practice Address - Fax:949-492-0047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44939261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental