Healthcare Provider Details

I. General information

NPI: 1508108382
Provider Name (Legal Business Name): DONALD EDWARD PLOURDE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 LOWELL ST
PEABODY MA
01960-4257
US

IV. Provider business mailing address

113 LOWELL ST
PEABODY MA
01960-4257
US

V. Phone/Fax

Practice location:
  • Phone: 978-532-0288
  • Fax: 978-977-6382
Mailing address:
  • Phone: 978-532-0288
  • Fax: 978-977-6382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number17793
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: