MEDICARE: SCOTT W 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	12007263A	IN

General Provider Information

NPI Number	:	1669477519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT W MCDONALD D.D.S.

Provider Business Mailing Address
First Line	:	1010 E 86TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-1868
Country	:	US
Telephone Number	:	317-846-6188
Fax Number	:	317-846-8861

Provider Business Practice Location Address
First Line	:	1010 E 86TH ST
Second Line	:	1040 BLDG., SUITE 40A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-1868
Country	:	US
Telephone Number	:	317-846-6188
Fax Number	:	317-846-8861

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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