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General NPI Number Information
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NPI Number | 1013092584
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Entity Type | Organization
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Legal Business Name | MICHAEL J.H. MCDONALD DMD,INC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1430 TARA HILLS DR SUITE B
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City | PINOLE
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State | CA
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Zip | 94564-2580
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Country | US
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Telephone | 510-724-5064
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Fax | 510-724-1887
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Provider Business Mailing Address
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Address Line | 1430 TARA HILLS DR SUITE B
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City | PINOLE
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State | CA
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Zip | 94564-2580
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Country | US
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Telephone | 510-724-5064
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Fax | 510-724-1887
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL J MCDONALD
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Credential | D.M.D.
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Telephone | 510-724-5064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 35644
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License Number State | CA
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