Provider Demographics
NPI:1750486650
Name:MACDONALD, DANIEL EDWIN (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:EDWIN
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CHURCH LN
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-2922
Mailing Address - Country:US
Mailing Address - Phone:914-472-4705
Mailing Address - Fax:
Practice Address - Street 1:40 CHURCH LN
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-2922
Practice Address - Country:US
Practice Address - Phone:914-472-4705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040071122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist