Healthcare Provider Details

I. General information

NPI: 1063111284
Provider Name (Legal Business Name): ALEC HUNTER MCDONALD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3684 US-150 SUITE 1
FLOYDS KNOBS IN
47119
US

IV. Provider business mailing address

5805 RUBY FALLS DR
PROSPECT KY
40059-8596
US

V. Phone/Fax

Practice location:
  • Phone: 812-923-9839
  • Fax:
Mailing address:
  • Phone: 317-373-6446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12014732A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: