Provider Demographics
NPI:1902964091
Name:MACDONALD, DONALD HUGH (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:HUGH
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 LOMA VISTA RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2935
Mailing Address - Country:US
Mailing Address - Phone:805-653-1599
Mailing Address - Fax:805-653-6234
Practice Address - Street 1:3003 LOMA VISTA RD
Practice Address - Street 2:SUITE G
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2935
Practice Address - Country:US
Practice Address - Phone:805-653-1599
Practice Address - Fax:805-653-6234
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA270291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA605899OtherUNITED CONCORDIA