Provider Demographics
NPI:1356553770
Name:ROBERT L. DONALD, JR., D.D.S. PLLC
Entity type:Organization
Organization Name:ROBERT L. DONALD, JR., D.D.S. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:DONALD, JR.
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:601-643-2222
Mailing Address - Street 1:PO BOX 8336
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39441-8336
Mailing Address - Country:US
Mailing Address - Phone:601-649-2222
Mailing Address - Fax:601-649-0255
Practice Address - Street 1:3228 OLD BAY SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-1453
Practice Address - Country:US
Practice Address - Phone:301-649-2222
Practice Address - Fax:601-649-0255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS795561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty