Provider Demographics
NPI:1215032073
Name:MCDONALD, LEANNE L (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEANNE
Middle Name:L
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E PUSHMATAHA ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:AL
Mailing Address - Zip Code:36904-2533
Mailing Address - Country:US
Mailing Address - Phone:205-459-5535
Mailing Address - Fax:
Practice Address - Street 1:325 E PUSHMATAHA ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:AL
Practice Address - Zip Code:36904-2533
Practice Address - Country:US
Practice Address - Phone:205-459-5535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL48011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL671736OtherUNITED CONDORDIA PROVIDER
AL34063OtherBC/BS AL PROVIDER #