Provider Demographics
NPI:1245389808
Name:MACDONALD, WILLAIM D (DMD)
Entity type:Individual
Prefix:
First Name:WILLAIM
Middle Name:D
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 1:1130 PROFESSIONAL LN
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7193
Mailing Address - Country:US
Mailing Address - Phone:843-216-5879
Mailing Address - Fax:843-216-5891
Practice Address - Street 1:389 JOHNNIE DODDS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-2950
Practice Address - Country:US
Practice Address - Phone:843-884-7041
Practice Address - Fax:843-971-9299
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38811223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3881Medicaid