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General NPI Number Information
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NPI Number | 1114906781
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Entity Type | Organization
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Legal Business Name | MARK S MACDONALD INC
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Dates
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Enumeration Date | 01/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 22944 W OUTER DR
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City | DEARBORN
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State | MI
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Zip | 48124
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Country | US
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Telephone | 313-563-2522
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Fax | 313-563-2522
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Provider Business Mailing Address
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Address Line | 22944 W OUTER DR
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City | DEARBORN
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State | MI
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Zip | 48124
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Country | US
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Telephone | 313-563-2522
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Fax | 313-563-2522
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | MARK STEVEN MACDONALD
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Credential | DDS
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Telephone | 313-563-2522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901014432
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License Number State | MI
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