Healthcare Provider Details

I. General information

NPI: 1669477519
Provider Name (Legal Business Name): SCOTT W MCDONALD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E 86TH ST 1040 BLDG., SUITE 40A
INDIANAPOLIS IN
46240-1868
US

IV. Provider business mailing address

1010 E 86TH ST
INDIANAPOLIS IN
46240-1868
US

V. Phone/Fax

Practice location:
  • Phone: 317-846-6188
  • Fax: 317-846-8861
Mailing address:
  • Phone: 317-846-6188
  • Fax: 317-846-8861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12007263A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: