Provider Demographics
NPI:1053628073
Name:DONAHUE, ROBERT GERARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GERARD
Last Name:DONAHUE
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 1:5225 WISCONSIN AVE NW
Mailing Address - Street 2:SUITE 309
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2014
Mailing Address - Country:US
Mailing Address - Phone:202-966-4050
Mailing Address - Fax:202-966-5046
Practice Address - Street 1:5225 WISCONSIN AVE NW
Practice Address - Street 2:SUITE 309
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2014
Practice Address - Country:US
Practice Address - Phone:202-966-4050
Practice Address - Fax:202-966-5046
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCD4572122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist