Provider Demographics
NPI:1508108382
Name:PLOURDE, DONALD EDWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:EDWARD
Last Name:PLOURDE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 LOWELL ST
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-4257
Mailing Address - Country:US
Mailing Address - Phone:978-532-0288
Mailing Address - Fax:978-977-6382
Practice Address - Street 1:113 LOWELL ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-4257
Practice Address - Country:US
Practice Address - Phone:978-532-0288
Practice Address - Fax:978-977-6382
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17793122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist