Provider Demographics
NPI:1154611390
Name:MCDONALD, ALEX R (PHD, DDS)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:R
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:PHD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 WEBSTER ST STE 810
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3123
Mailing Address - Country:US
Mailing Address - Phone:510-832-4466
Mailing Address - Fax:510-832-4566
Practice Address - Street 1:3300 WEBSTER ST.,
Practice Address - Street 2:810
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3117
Practice Address - Country:US
Practice Address - Phone:510-832-4466
Practice Address - Fax:510-832-4566
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA420681223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1659415743OtherNPI