Provider Demographics
NPI:1851475248
Name:MCDONALD, KATHLEEN E (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:E
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 S AVENUE A
Mailing Address - Street 2:SUITE B
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8341
Mailing Address - Country:US
Mailing Address - Phone:928-783-8481
Mailing Address - Fax:928-343-0055
Practice Address - Street 1:2244 S AVENUE A
Practice Address - Street 2:SUITE B
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8341
Practice Address - Country:US
Practice Address - Phone:928-783-8481
Practice Address - Fax:928-343-0055
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ56221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice