Brent Allen McDonald, D.D.S.
Individual provider Active NPI General Practice Dentistry · MC Cordsville, IN
NPI 1275607012 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1275607012
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 12010363A (IN)
- Practice address
- 5842 W Broadway
MC Cordsville, IN 46055-9343 - Phone
- (317) 336-7788
- Fax
- (317) 336-7277
- NPI assigned
- Nov 20, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- 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 |
|---|---|---|---|---|
| I20170531000506 | IN | Order and Referring Only - Dentist |
9234450057 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12010363A | IN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| McDonald Family Dentistry PC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12010363A | IN | Yes |
Addresses
Primary practice location
5842 W Broadway
MC Cordsville, IN 46055-9343
Mailing address
5842 W Broadway
MC Cordsville, IN 46055-9343
Phone (317) 336-7788
Other providers in MC Cordsville, IN
- Vicki Kay Eckert
- Nakisha R Gaddie
- Serina L Helderbreand
- Hook-Superx LLC
- Kelli Larrabee - Dewell
- Christie Goodpaster McDonald
- Medpsych Consultants PC
- Montessori Academy at Geist, Inc.
- Open Door Equine Inc
- Potter Family Eye Care, LLC
All providers in MC Cordsville, IN · General Practice Dentistry in Indiana
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.