Provider Demographics
NPI:1023471513
Name:MEADOW DENTAL CENTER, P.C.
Entity type:Organization
Organization Name:MEADOW DENTAL CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:MCDONOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-628-9721
Mailing Address - Street 1:1943 SMITH TOWNSHIP STATE ROAD
Mailing Address - Street 2:P.O. BOX 306
Mailing Address - City:SLOVAN
Mailing Address - State:PA
Mailing Address - Zip Code:15078-0000
Mailing Address - Country:US
Mailing Address - Phone:724-947-5880
Mailing Address - Fax:724-947-9660
Practice Address - Street 1:1943 SMITH TOWNSHIP STATE ROAD
Practice Address - Street 2:306
Practice Address - City:SLOVAN
Practice Address - State:PA
Practice Address - Zip Code:15078-1111
Practice Address - Country:US
Practice Address - Phone:724-947-5880
Practice Address - Fax:724-947-9660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-030565-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty