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General NPI Number Information
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NPI Number | 1942632302
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Entity Type | Individual
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Provider Name | MATTHEW WILLIAM MCDONALD D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/07/2013
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Last Update Date | 08/07/2013
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Provider Practice Location Address
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Address Line | 13983 MANGO DR STE. 202
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City | DEL MAR
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State | CA
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Zip | 92014-3131
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Country | US
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Telephone | 425-417-4509
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Fax |
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Provider Business Mailing Address
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Address Line | 1608 N RIM VIEW ST
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City | SPOKANE
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State | WA
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Zip | 99224-5147
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Country | US
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Telephone | 425-417-4509
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 62651
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License Number State | CA
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