Individual
DR. ROBERT MCDONOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6695 E US HIGHWAY 36, AVON, IN 46123-8923
(317) 272-2200
(317) 272-3714
Mailing address
6695 E US HIGHWAY 36, AVON, IN 46123-8923
(317) 272-2200
(317) 272-3714
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
12008806
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000088447
ANTHEM
IN
Enumeration date
08/01/2005
Last updated
03/10/2008
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