Provider Demographics
NPI:1265517734
Name:MCDONALD, MICHAEL JH (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JH
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:1430 TARA HILLS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2580
Mailing Address - Country:US
Mailing Address - Phone:510-724-5064
Mailing Address - Fax:510-724-1887
Practice Address - Street 1:1430 TARA HILLS DR
Practice Address - Street 2:SUITE B
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2580
Practice Address - Country:US
Practice Address - Phone:510-724-5064
Practice Address - Fax:510-724-1887
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA356441223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery