Provider Demographics
NPI:1679583116
Name:MACDONALD, SANDRA L (DMD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:L
Last Name:MACDONALD
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 1:110 LONG POND ROAD
Mailing Address - Street 2:#204
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360
Mailing Address - Country:US
Mailing Address - Phone:508-830-3339
Mailing Address - Fax:508-830-1976
Practice Address - Street 1:110 LONG POND ROAD
Practice Address - Street 2:#204
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360
Practice Address - Country:US
Practice Address - Phone:508-830-3339
Practice Address - Fax:508-830-1976
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA177261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice