Provider Demographics
NPI:1619674470
Name:KARLA R MCDONALD DDS LLC
Entity Type:Organization
Organization Name:KARLA R MCDONALD DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-570-0348
Mailing Address - Street 1:1121 ROBIN CIR
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-3118
Mailing Address - Country:US
Mailing Address - Phone:715-712-0424
Mailing Address - Fax:715-712-0424
Practice Address - Street 1:406 DALY AVE
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-4744
Practice Address - Country:US
Practice Address - Phone:715-421-1515
Practice Address - Fax:715-423-8552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1124463443OtherNPI