Provider Demographics
NPI:1427172022
Name:MCDONALD, EDWIN ALLEN III (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:ALLEN
Last Name:MCDONALD
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 LAREDO CIR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5439
Mailing Address - Country:US
Mailing Address - Phone:469-241-9000
Mailing Address - Fax:469-241-0446
Practice Address - Street 1:5800 COIT RD
Practice Address - Street 2:STE 100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-5942
Practice Address - Country:US
Practice Address - Phone:469-241-9000
Practice Address - Fax:469-241-0446
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX126741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice