Provider Demographics
NPI:1184304032
Name:MCDOUGALL, RILEY (DMD)
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:MCDOUGALL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 E DEDHAM ST APT 821
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3559
Mailing Address - Country:US
Mailing Address - Phone:351-201-4644
Mailing Address - Fax:
Practice Address - Street 1:855 BROADWAY STE 8
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-3579
Practice Address - Country:US
Practice Address - Phone:781-231-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859950122300000X
MASTUDENT122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist