Provider Demographics
NPI:1821212846
Name:MCDONALD, PETER JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JAMES
Last Name:MCDONALD
Suffix:
Gender:M
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:PO BOX 5666
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58206-5666
Mailing Address - Country:US
Mailing Address - Phone:701-757-3025
Mailing Address - Fax:701-757-3028
Practice Address - Street 1:2830 S COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6008
Practice Address - Country:US
Practice Address - Phone:701-757-3025
Practice Address - Fax:701-757-3028
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2394122300000X
MN12117122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND949285OtherBCBS ND