=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386833184
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KATHLEEN E. MCDONALD, DMD,PC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2007
-----------------------------------------------------
Last Update Date | 11/19/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2244 S AVE A SUITE B
-----------------------------------------------------
City | YUMA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85364-8341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-783-8481
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2244 S AVE A SUITE B
-----------------------------------------------------
City | YUMA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85364-8341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-783-8481
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. KATHLEEN EDME MCDONALD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 928-783-8481
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 5622
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------