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General NPI Number Information
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NPI Number | 1356553770
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Entity Type | Organization
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Legal Business Name | ROBERT L. DONALD, JR., D.D.S. PLLC
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Dates
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Enumeration Date | 05/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3228 OLD BAY SPRINGS RD
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City | LAUREL
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State | MS
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Zip | 39440-1453
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Country | US
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Telephone | 301-649-2222
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Fax | 601-649-0255
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Provider Business Mailing Address
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Address Line | PO BOX 8336
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City | LAUREL
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State | MS
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Zip | 39441-8336
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Country | US
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Telephone | 601-649-2222
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Fax | 601-649-0255
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT L. DONALD, JR.
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Credential | D.D.S.
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Telephone | 601-643-2222
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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 | 79556
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License Number State | MS
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