Provider Demographics
NPI:1235626094
Name:MCDONALD, DEXTER L JR
Entity Type:Individual
Prefix:MR
First Name:DEXTER
Middle Name:L
Last Name:MCDONALD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4165 WENDY LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-0177
Mailing Address - Country:US
Mailing Address - Phone:702-907-1055
Mailing Address - Fax:
Practice Address - Street 1:2280 E CALVADA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-5846
Practice Address - Country:US
Practice Address - Phone:702-907-1055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner