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NPI Code Detail

MEDICARE: DR. CHRISTIE GOODPASTER MCDONALD D.D.S.

MEDICARE:  DR. CHRISTIE GOODPASTER 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
11223G0001XGeneral Practice Dentistry12010590AIN

General Provider Information

NPI Number : 1538233374
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHRISTIE GOODPASTER MCDONALD D.D.S.
Provider Business Mailing Address
First Line : 5842 W BROADWAY
Second Line :
City : MC CORDSVILLE
State : IN
Zip : 46055-9343
Country : US
Telephone Number : 317-336-7788
Fax Number : 317-336-7277
Provider Business Practice Location Address
First Line : 5842 W BROADWAY
Second Line :
City : MC CORDSVILLE
State : IN
Zip : 46055-9343
Country : US
Telephone Number : 317-336-7788
Fax Number : 317-336-7277
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2006
Last Update Date : 07/08/2007

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Directions to “ DR. CHRISTIE GOODPASTER MCDONALD D.D.S.” Practice Location

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