Provider Demographics
NPI:1023085305
Name:MCDONALD, KEITH E (DMD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:E
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 DUVALL AVE NE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-4675
Mailing Address - Country:US
Mailing Address - Phone:425-228-5437
Mailing Address - Fax:425-663-7990
Practice Address - Street 1:451 DUVALL AVE NE
Practice Address - Street 2:SUITE 140
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-4675
Practice Address - Country:US
Practice Address - Phone:425-228-5437
Practice Address - Fax:425-663-7990
Is Sole Proprietor?:No
Enumeration Date:2006-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000100421223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5048921Medicaid