Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 2014021256 | MO |
Y | 1223X0400X | Orthodontists | DD4636 | NM |
NPI | 1053710293 |
---|---|
Provider Name | Dr. Andrew Mcdonald |
First Address | Albuquerque, NM 87109 |
Second Address | Albuquerque, NM 87109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2014 |
Last Update Date | 18/06/2019 |