Provider Demographics
NPI:1619116902
Name:MCDONALD, ALECIA LOUISE SKIPPER (DMD)
Entity Type:Individual
Prefix:
First Name:ALECIA
Middle Name:LOUISE SKIPPER
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 NW 7TH PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32603-1210
Mailing Address - Country:US
Mailing Address - Phone:352-262-5639
Mailing Address - Fax:
Practice Address - Street 1:1604 NW 7TH PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32603-1210
Practice Address - Country:US
Practice Address - Phone:352-262-5639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17110122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist