Provider Demographics
NPI:1124331731
Name:MCDONALD, YAA NOEL (DMD)
Entity type:Individual
Prefix:
First Name:YAA
Middle Name:NOEL
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16345 HARLEM AVENUE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60651-3511
Mailing Address - Country:US
Mailing Address - Phone:773-290-3500
Mailing Address - Fax:
Practice Address - Street 1:16345 HARLEM AVENUE
Practice Address - Street 2:SUITE 150
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60559-1514
Practice Address - Country:US
Practice Address - Phone:708-633-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-24
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210026131223P0221X
IL019028415122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist