Provider Demographics
NPI:1891718110
Name:MACDONALD, JOLANTA MARIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOLANTA
Middle Name:MARIA
Last Name:MACDONALD
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 1:137 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532
Mailing Address - Country:US
Mailing Address - Phone:508-393-9394
Mailing Address - Fax:508-393-9364
Practice Address - Street 1:137 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532
Practice Address - Country:US
Practice Address - Phone:508-393-9394
Practice Address - Fax:508-393-9364
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20433122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist