Provider Demographics
NPI:1871672154
Name:M T MCDONALD DDS PS
Entity Type:Organization
Organization Name:M T MCDONALD DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-352-4008
Mailing Address - Street 1:1205 HARRISON AVE NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5494
Mailing Address - Country:US
Mailing Address - Phone:360-352-4008
Mailing Address - Fax:360-534-0479
Practice Address - Street 1:1205 HARRISON AVE NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5494
Practice Address - Country:US
Practice Address - Phone:360-352-4008
Practice Address - Fax:360-534-0479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty