Provider Demographics
NPI:1033285069
Name:DONNELLY, PATRICIA KATHLEEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:KATHLEEN
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S GLENDORA AVE #250
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-6239
Mailing Address - Country:US
Mailing Address - Phone:626-963-4464
Mailing Address - Fax:626-963-4166
Practice Address - Street 1:410 S GLENDORA AVE #250
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-6239
Practice Address - Country:US
Practice Address - Phone:626-963-4464
Practice Address - Fax:626-963-4166
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA031565122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist