Provider Demographics
NPI:1386736676
Name:MCDONALD, ELLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 AIRPORT RD
Mailing Address - Street 2:SPACE G
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-4060
Mailing Address - Country:US
Mailing Address - Phone:501-321-3503
Mailing Address - Fax:501-321-4973
Practice Address - Street 1:221 AIRPORT RD
Practice Address - Street 2:SPACE G
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-4060
Practice Address - Country:US
Practice Address - Phone:501-321-3503
Practice Address - Fax:501-321-4973
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR28771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice