Provider Demographics
NPI:1558360461
Name:MCDONALD, JOHN SANFORD (DDSMS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SANFORD
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:DDSMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 PIEDMONT AVE
Mailing Address - Street 2:SUITE 8400
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-4231
Mailing Address - Country:US
Mailing Address - Phone:513-475-7662
Mailing Address - Fax:513-475-7666
Practice Address - Street 1:222 PIEDMONT AVE
Practice Address - Street 2:SUITE 8400
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-4231
Practice Address - Country:US
Practice Address - Phone:513-475-7662
Practice Address - Fax:513-475-7666
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-016274207ZP0101X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0512348Medicare PIN
OHMC0512341Medicare ID - Type Unspecified
OHT47550Medicare UPIN