Provider Demographics
NPI:1235317678
Name:MCDONALD-WIN-E-MAC DENTAL
Entity Type:Organization
Organization Name:MCDONALD-WIN-E-MAC DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-563-3001
Mailing Address - Street 1:105 2ND ST SW
Mailing Address - Street 2:PO BOX 265
Mailing Address - City:MCINTOSH
Mailing Address - State:MN
Mailing Address - Zip Code:56556
Mailing Address - Country:US
Mailing Address - Phone:218-563-3001
Mailing Address - Fax:218-563-3002
Practice Address - Street 1:105 2ND ST SW
Practice Address - Street 2:
Practice Address - City:MCINTOSH
Practice Address - State:MN
Practice Address - Zip Code:56556
Practice Address - Country:US
Practice Address - Phone:218-563-3001
Practice Address - Fax:218-563-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND121171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty