MEDICARE: DR. GREGORY A. MCDONALD D.D.S.

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	1223G0001X	General Practice Dentistry	018367	OH

General Provider Information

NPI Number	:	1902098163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY A. MCDONALD D.D.S.

Provider Business Mailing Address
First Line	:	11740 HAMILTON AVE
Second Line	:	SUITE A
City	:	CINCINNATI
State	:	OH
Zip	:	45231-1129
Country	:	US
Telephone Number	:	513-825-7570
Fax Number	:	513-825-7999

Provider Business Practice Location Address
First Line	:	11740 HAMILTON AVE
Second Line	:	SUITE A
City	:	CINCINNATI
State	:	OH
Zip	:	45231-1129
Country	:	US
Telephone Number	:	513-825-7570
Fax Number	:	513-825-7999

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

Provider Enumeration Date	:	08/13/2007
Last Update Date	:	08/13/2007

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