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General NPI Number Information
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NPI Number | 1063604429
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Entity Type | Individual
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Provider Name | MARK T MCDONALD DDS
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Gender | Male
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 04/19/2023
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Provider Practice Location Address
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Address Line | 3246 12TH AVE RD
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City | NAMPA
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State | ID
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Zip | 83686-8404
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Country | US
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Telephone | 208-467-9690
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Fax | 208-466-0412
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Provider Business Mailing Address
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Address Line | 3246 12TH AVE RD
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City | NAMPA
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State | ID
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Zip | 83686-8404
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Country | US
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Telephone | 208-467-9690
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D3958
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License Number State | ID
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