Keith Thomas Macdonald, D.D.S.
Individual provider Active NPI General Practice Dentistry · Archdale, NC
NPI 1124138771 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1124138771
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 4921 (NC)
- Practice address
- 9924 US Highway 311
Archdale, NC 27263-8826 - Phone
- (336) 434-3186
- Fax
- (336) 434-3189
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160108001256 | NC | Order and Referring Only - Oral Surgery |
9830491794 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4921 | NC | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr. Keith T. Macdonald | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4921 | NC | Yes |
Addresses
Primary practice location
9924 US Highway 311
Archdale, NC 27263-8826
Mailing address
3804 Gaston Rd
Greensboro, NC 27407-7759
Phone (336) 294-1549
Other providers in Archdale, NC
- Muhan Lily Li
- Joanna Lindsay
- Laquanna M Lucas
- Bradley Joseph Macdonald
- Daniel John Macdonald
- Marnie S Marlette
- Brooke Stroud Martin
- Brittany Donathan McManus
- Medberry LLC
- Mediq Urgent Care PC
All providers in Archdale, NC · General Practice Dentistry in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.