Provider Demographics
NPI:1457495780
Name:PETER J MCDONALD DDS PC
Entity Type:Organization
Organization Name:PETER J MCDONALD DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-382-6108
Mailing Address - Street 1:114 N FRANKLIN ST
Mailing Address - Street 2:P.O. BOX 849
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-2953
Mailing Address - Country:US
Mailing Address - Phone:540-382-6108
Mailing Address - Fax:540-382-0315
Practice Address - Street 1:114 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-2953
Practice Address - Country:US
Practice Address - Phone:540-382-6108
Practice Address - Fax:540-382-0315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010044591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty