Provider Demographics
NPI:1134311772
Name:MCDONALD, JOHN LEWIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LEWIS
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1855 W NOB HILL ST SE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5287
Mailing Address - Country:US
Mailing Address - Phone:503-585-5400
Mailing Address - Fax:503-362-0546
Practice Address - Street 1:1855 W NOB HILL ST SE
Practice Address - Street 2:SUITE 300
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-5287
Practice Address - Country:US
Practice Address - Phone:503-585-5400
Practice Address - Fax:503-362-0546
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD65311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics