Provider Demographics
NPI:1639616139
Name:CORNALI & MCDONALD ORTHODONTIC SPECIALITST LTD. CO.
Entity Type:Organization
Organization Name:CORNALI & MCDONALD ORTHODONTIC SPECIALITST LTD. CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-828-1244
Mailing Address - Street 1:8010 PALOMAS AVE NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-5201
Mailing Address - Country:US
Mailing Address - Phone:505-828-1244
Mailing Address - Fax:505-828-1447
Practice Address - Street 1:8010 PALOMAS AVE NE
Practice Address - Street 2:SUITE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5201
Practice Address - Country:US
Practice Address - Phone:505-828-1244
Practice Address - Fax:505-828-1447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD46361223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty