MEDICARE: THOMAS JOHN MCDONALD D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2901014262	MI

General Provider Information

NPI Number	:	1205924586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS JOHN MCDONALD D.D.S.

Provider Business Mailing Address
First Line	:	117 S KINNEY AVE
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-2702
Country	:	US
Telephone Number	:	989-773-2133
Fax Number	:	989-779-1094

Provider Business Practice Location Address
First Line	:	117 S KINNEY AVE
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-2702
Country	:	US
Telephone Number	:	989-732-1337
Fax Number	:	989-779-1094

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	12/14/2021

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