Provider Demographics
NPI:1750470324
Name:M. T. MCDONALD, D. D. S., P. A.
Entity Type:Organization
Organization Name:M. T. MCDONALD, D. D. S., P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:D D S
Authorized Official - Phone:662-256-5601
Mailing Address - Street 1:400 2ND AVE N
Mailing Address - Street 2:P. O. BOX 421
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-3513
Mailing Address - Country:US
Mailing Address - Phone:662-256-5601
Mailing Address - Fax:662-256-5602
Practice Address - Street 1:400 2ND AVE N
Practice Address - Street 2:
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-3513
Practice Address - Country:US
Practice Address - Phone:662-256-5601
Practice Address - Fax:662-256-5602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1549-731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty