Provider Demographics
NPI:1558522037
Name:MCDONALD, PAUL PORTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:PORTER
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 EAST PACES FERRY ROAD
Mailing Address - Street 2:SUITE 709
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-261-1486
Mailing Address - Fax:404-261-1486
Practice Address - Street 1:309 EAST PACES FERRY ROAD
Practice Address - Street 2:SUITE 709
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305
Practice Address - Country:US
Practice Address - Phone:404-261-1486
Practice Address - Fax:404-261-1486
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9452122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist