Healthcare Provider Details

I. General information

NPI: 1841407954
Provider Name (Legal Business Name): JANET JILL MCDONALD DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4113 UNION RD
SAINT LOUIS MO
63129-1064
US

IV. Provider business mailing address

60 FAIRGROUNDS RD # A
PARIS TN
38242-5648
US

V. Phone/Fax

Practice location:
  • Phone: 203-530-3136
  • Fax:
Mailing address:
  • Phone: 731-642-2314
  • Fax: 731-642-2317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2023001624
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7051
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: