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General NPI Number Information
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NPI Number | 1629074174
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Entity Type | Organization
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Legal Business Name | M.A. MCDONALD, D.D.S., INC
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1606 N LEBANON ST
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City | LEBANON
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State | IN
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Zip | 46052-1514
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Country | US
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Telephone | 765-482-6622
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Fax |
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Provider Business Mailing Address
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Address Line | 1606 N LEBANON ST
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City | LEBANON
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State | IN
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Zip | 46052-1514
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Country | US
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Telephone | 765-482-6622
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL ALLEN MCDONALD
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Credential | D.D.S
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Telephone | 765-482-6672
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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 | 6967
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License Number State | IN
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