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General NPI Number Information
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NPI Number | 1194866418
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Entity Type | Organization
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Legal Business Name | FT MCDONALD DDS LTD
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3900 S OLIVE ST
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City | PINE BLUFF
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State | AR
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Zip | 71603-6745
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Country | US
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Telephone | 870-536-6430
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Fax |
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Provider Business Mailing Address
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Address Line | 3900 S OLIVE ST
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City | PINE BLUFF
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State | AR
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Zip | 71603-6745
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Country | US
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Telephone | 879-036-6430
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | FRED MCDONALD
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Credential |
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Telephone | 870-536-6430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 1983
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License Number State | AR
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