Provider Demographics
NPI:1033278379
Name:DONOHUE, TERRY JAMES (DDS)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:JAMES
Last Name:DONOHUE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 848
Mailing Address - Street 2:323 WEST MAPLE STREET
Mailing Address - City:CARSON CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48811-0848
Mailing Address - Country:US
Mailing Address - Phone:989-584-3171
Mailing Address - Fax:989-584-3013
Practice Address - Street 1:323 WEST MAPLE STREET
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:MI
Practice Address - Zip Code:48811-0848
Practice Address - Country:US
Practice Address - Phone:989-584-3171
Practice Address - Fax:989-584-3013
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI012477122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4550367Medicaid
MIAD9386649OtherDEA