Provider Demographics
NPI:1477529253
Name:MCDONALD, MARCUS F (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:F
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:DMD
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Other - Credentials:
Mailing Address - Street 1:577 STERNBERG AVE
Mailing Address - Street 2:HQ USADENTAC CREDENTIALS OFFICE
Mailing Address - City:FORT EUSTIS
Mailing Address - State:VA
Mailing Address - Zip Code:23604-1526
Mailing Address - Country:US
Mailing Address - Phone:757-314-7944
Mailing Address - Fax:757-314-7942
Practice Address - Street 1:577 STERNBERG AVE
Practice Address - Street 2:HQ USADENTAC CREDENTIALS OFFICE
Practice Address - City:FORT EUSTIS
Practice Address - State:VA
Practice Address - Zip Code:23604-1526
Practice Address - Country:US
Practice Address - Phone:757-314-7944
Practice Address - Fax:757-314-7942
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL36891223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics