MEDICARE: MR. RICHARD SCOTT MCDONALD DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	12997	TX

General Provider Information

NPI Number	:	1366434359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD SCOTT MCDONALD DDS

Provider Business Mailing Address
First Line	:	4255 BRYANT IRVIN RD
Second Line	:	STE 111
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4233
Country	:	US
Telephone Number	:	817-731-9487
Fax Number	:	817-731-2846

Provider Business Practice Location Address
First Line	:	4255 BRYANT IRVIN RD
Second Line	:	STE 111
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4233
Country	:	US
Telephone Number	:	817-731-9487
Fax Number	:	817-731-2846

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	01/03/2012

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