Provider Demographics
NPI:1013916469
Name:MCDONALD, ROY A (DDS, PC)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:A
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 ROYAL BLVD S
Mailing Address - Street 2:STE 250
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-1409
Mailing Address - Country:US
Mailing Address - Phone:770-667-6453
Mailing Address - Fax:770-667-7430
Practice Address - Street 1:3005 ROYAL BLVD S
Practice Address - Street 2:STE 250
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1409
Practice Address - Country:US
Practice Address - Phone:770-667-6453
Practice Address - Fax:770-667-7340
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2015-01-05
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
GA97551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice