Provider Demographics
NPI:1366518672
Name:MCDONALD ORTHODONTICS
Entity type:Organization
Organization Name:MCDONALD ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-585-5400
Mailing Address - Street 1:1855 WEST NOB HILL ST SE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302
Mailing Address - Country:US
Mailing Address - Phone:503-585-5400
Mailing Address - Fax:503-362-0546
Practice Address - Street 1:1855 WEST NOB HILL ST SE
Practice Address - Street 2:SUITE 300
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302
Practice Address - Country:US
Practice Address - Phone:503-585-5400
Practice Address - Fax:503-362-0546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD65311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty