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General NPI Number Information
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NPI Number | 1750825378
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Entity Type | Organization
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Legal Business Name | MCDONALD FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 12/16/2016
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Last Update Date | 04/27/2017
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Provider Practice Location Address
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Address Line | 3310 FRANKLIN RD SW
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City | ROANOKE
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State | VA
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Zip | 24014-1310
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Country | US
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Telephone | 540-342-7221
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Fax | 540-400-8304
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Provider Business Mailing Address
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Address Line | 3310 FRANKLIN RD SW
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City | ROANOKE
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State | VA
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Zip | 24014-1310
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Country | US
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Telephone | 540-342-7221
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Fax | 540-400-8304
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Authorized Official
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Title or Position | DENTIST/PRACTICE OWNER
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Name | DR. BENJAMIN MCDONALD
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Credential | DDS
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Telephone | 540-342-7221
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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 |
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License Number State | VA
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