Provider Demographics
NPI:1831649862
Name:MCDONALD, LAURA COLLEEN (DDS)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:COLLEEN
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 MCKINNEY AVE APT 359
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1693
Mailing Address - Country:US
Mailing Address - Phone:956-279-5360
Mailing Address - Fax:
Practice Address - Street 1:1315 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-5324
Practice Address - Country:US
Practice Address - Phone:214-941-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX322071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice