Provider Demographics
NPI:1427120419
Name:MCDONALD, DIANNE MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:MARIE
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 1:17500 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3535
Mailing Address - Country:US
Mailing Address - Phone:216-521-2424
Mailing Address - Fax:216-521-8497
Practice Address - Street 1:17500 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3535
Practice Address - Country:US
Practice Address - Phone:216-521-2424
Practice Address - Fax:216-521-8497
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0154791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH30.015479OtherDENTAL LICENSE
FL7928OtherDENTAL LICENSE