Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DE00010042 | WA |
NPI | 1023085305 |
---|---|
Provider Name | Dr. Keith E. Mcdonald |
First Address | Renton, WA 98059-4675 |
Second Address | Renton, WA 98059-4675 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5048921 | (05) | WA |