Provider Demographics
NPI:1760401095
Name:MCDONALD, GEORGIA KAY (DDS)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:KAY
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 VENDOME PL
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-2740
Mailing Address - Country:US
Mailing Address - Phone:504-858-7829
Mailing Address - Fax:
Practice Address - Street 1:4201 VENDOME PL
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-2740
Practice Address - Country:US
Practice Address - Phone:504-858-7829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA42031223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics