Healthcare Provider Details

I. General information

NPI: 1215032073
Provider Name (Legal Business Name): LEANNE L MCDONALD D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E PUSHMATAHA ST
BUTLER AL
36904-2533
US

IV. Provider business mailing address

325 E PUSHMATAHA ST
BUTLER AL
36904-2533
US

V. Phone/Fax

Practice location:
  • Phone: 205-459-5535
  • Fax:
Mailing address:
  • Phone: 205-459-5535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4801
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: