Provider Demographics
NPI:1386833184
Name:KATHLEEN E. MCDONALD, DMD,PC.
Entity Type:Organization
Organization Name:KATHLEEN E. MCDONALD, DMD,PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:EDME
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-783-8481
Mailing Address - Street 1:2244 S AVE A
Mailing Address - Street 2:SUITE B
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8341
Mailing Address - Country:US
Mailing Address - Phone:928-783-8481
Mailing Address - Fax:
Practice Address - Street 1:2244 S AVE A
Practice Address - Street 2:SUITE B
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8341
Practice Address - Country:US
Practice Address - Phone:928-783-8481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5622261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental