Provider Demographics
NPI:1205924586
Name:MCDONALD, THOMAS JOHN (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOHN
Last Name:MCDONALD
Suffix:
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 1:117 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:989-779-1094
Practice Address - Street 1:117 S KINNEY AVE
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2702
Practice Address - Country:US
Practice Address - Phone:989-732-1337
Practice Address - Fax:989-779-1094
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010142621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice