Provider Demographics
NPI:1366896490
Name:THOMAS J MCDONALD DDS PC
Entity type:Organization
Organization Name:THOMAS J MCDONALD DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-773-2133
Mailing Address - Street 1:117 S KINNEY AVE
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2702
Mailing Address - Country:US
Mailing Address - Phone:989-773-2133
Mailing Address - Fax:989-779-1054
Practice Address - Street 1:117 S KINNEY AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2702
Practice Address - Country:US
Practice Address - Phone:989-773-2133
Practice Address - Fax:989-779-1054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI14262261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental