Provider Demographics
NPI:1073698411
Name:MAGER, DONNA L (DDS, DMSC)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:L
Last Name:MAGER
Suffix:
Gender:F
Credentials:DDS, DMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 E INDIA ROW
Mailing Address - Street 2:36B
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-3320
Mailing Address - Country:US
Mailing Address - Phone:617-557-0191
Mailing Address - Fax:617-573-9521
Practice Address - Street 1:85 E INDIA ROW
Practice Address - Street 2:36B
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-3320
Practice Address - Country:US
Practice Address - Phone:617-557-0191
Practice Address - Fax:617-573-9521
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA192591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice