Healthcare Provider Details

I. General information

NPI: 1558360461
Provider Name (Legal Business Name): JOHN SANFORD MCDONALD DDSMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 PIEDMONT AVE SUITE 8400
CINCINNATI OH
45219-4231
US

IV. Provider business mailing address

222 PIEDMONT AVE SUITE 8400
CINCINNATI OH
45219-4231
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-7662
  • Fax: 513-475-7666
Mailing address:
  • Phone: 513-475-7662
  • Fax: 513-475-7666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number30-016274
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number30-016274
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: