Healthcare Provider Details

I. General information

NPI: 1982138269
Provider Name (Legal Business Name): DAVID WILLIAM MACDONALD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 10/20/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 W FIGARDEN DR STE 101
FRESNO CA
93722-6071
US

IV. Provider business mailing address

4220 W FIGARDEN DR STE 101
FRESNO CA
93722-6071
US

V. Phone/Fax

Practice location:
  • Phone: 559-439-5200
  • Fax:
Mailing address:
  • Phone: 559-439-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number106580
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: