Provider Demographics
NPI:1245247469
Name:MCLAUGHLIN, MICHAEL ALLEN (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALLEN
Last Name:MCLAUGHLIN
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:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:DYSART
Mailing Address - State:IA
Mailing Address - Zip Code:52224-0160
Mailing Address - Country:US
Mailing Address - Phone:319-476-4110
Mailing Address - Fax:
Practice Address - Street 1:407 WILSON ST.
Practice Address - Street 2:
Practice Address - City:DYSART
Practice Address - State:IA
Practice Address - Zip Code:52224
Practice Address - Country:US
Practice Address - Phone:319-476-4110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA53941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0060434Medicaid
IA060434OtherUNIVERSAL #