Douglas John McNaught, DDS
Individual provider Active NPI General Practice Dentistry · Long Lake, MN
NPI 1679678973 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1679678973
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 9985 (MN)
- Practice address
- 1870 W. Wayzata Blvd.
Long Lake, MN 55356 - Phone
- (952) 473-7151
- Fax
- (952) 475-1539
- NPI assigned
- Sep 13, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
- Opted out of Medicare
- Previously, effective Aug 8, 2016 through Aug 8, 2026
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170609002141 | MN | Order and Referring Only - Dentist |
0042588394 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9985 | MN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Douglas J McNaught D D S P a | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 9985 | MN | Yes |
Addresses
Primary practice location
1870 W. Wayzata Blvd.
Long Lake, MN 55356
Mailing address
PO Box 695
1870 W. Wayzata Blvd.
Long Lake, MN 55356
Phone (952) 473-7151
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- Long Lake Eye LLC
- Joshua David Mazurek
- Kathryn Aschliman Muller
- Orono Public School District Isd 0278
- Orono Woodlands, Inc.
- Diane Pease
- Plante Chiropractic Center, Inc.
All providers in Long Lake, MN · General Practice Dentistry in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.