Provider Demographics
NPI:1629484563
Name:MCDONALD, TERESA (RDH)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13043 TRENTON PL
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-8434
Mailing Address - Country:US
Mailing Address - Phone:303-358-3297
Mailing Address - Fax:
Practice Address - Street 1:1557 W 84TH AVE
Practice Address - Street 2:
Practice Address - City:FEDERAL HEIGHTS
Practice Address - State:CO
Practice Address - Zip Code:80260-4780
Practice Address - Country:US
Practice Address - Phone:303-426-4860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2261124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist