Provider Demographics
NPI:1053465682
Name:MCDONALD, JAMES STANLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:STANLEY
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 CENTRAL AVE NW
Mailing Address - Street 2:
Mailing Address - City:EAST GRAND FORKS
Mailing Address - State:MN
Mailing Address - Zip Code:56721-1613
Mailing Address - Country:US
Mailing Address - Phone:218-773-3010
Mailing Address - Fax:218-773-9780
Practice Address - Street 1:1421 CENTRAL AVE NW
Practice Address - Street 2:
Practice Address - City:EAST GRAND FORKS
Practice Address - State:MN
Practice Address - Zip Code:56721-1613
Practice Address - Country:US
Practice Address - Phone:218-773-3010
Practice Address - Fax:218-773-9780
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND71141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND040679Medicaid