Provider Demographics
NPI:1831483247
Name:MACDONALD, CHARLES C III (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:C
Last Name:MACDONALD
Suffix:III
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 1:4771 STATE ROUTE 71
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-7415
Mailing Address - Country:US
Mailing Address - Phone:630-930-9339
Mailing Address - Fax:
Practice Address - Street 1:4771 STATE ROUTE 71
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-7415
Practice Address - Country:US
Practice Address - Phone:630-930-9339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2013-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190286191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice