Healthcare Provider Details

I. General information

NPI: 1245151729
Provider Name (Legal Business Name): ALEX KEITH MACDONALD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22363 E DOMINGO RD STE 101
QUEEN CREEK AZ
85142-0353
US

IV. Provider business mailing address

22363 E DOMINGO RD STE 101
QUEEN CREEK AZ
85142-0353
US

V. Phone/Fax

Practice location:
  • Phone: 480-766-1384
  • Fax:
Mailing address:
  • Phone: 480-912-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD012809
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: