Provider Demographics
NPI:1316116205
Name:DR. KEITH T. MACDONALD
Entity type:Organization
Organization Name:DR. KEITH T. MACDONALD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-434-3186
Mailing Address - Street 1:9924 US HIGHWAY 311
Mailing Address - Street 2:
Mailing Address - City:ARCHDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27263-8826
Mailing Address - Country:US
Mailing Address - Phone:336-434-3186
Mailing Address - Fax:336-434-3189
Practice Address - Street 1:9924 US HIGHWAY 311
Practice Address - Street 2:
Practice Address - City:ARCHDALE
Practice Address - State:NC
Practice Address - Zip Code:27263-8826
Practice Address - Country:US
Practice Address - Phone:336-434-3186
Practice Address - Fax:336-434-3189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC49211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC95437OtherBCBS