Provider Demographics
NPI:1073716858
Name:DONASTORG, AMPARO R (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMPARO
Middle Name:R
Last Name:DONASTORG
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:PO BOX 1017
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36831-1017
Mailing Address - Country:US
Mailing Address - Phone:334-466-8225
Mailing Address - Fax:
Practice Address - Street 1:118 N ROSS ST
Practice Address - Street 2:SUITE NO. 7
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-4857
Practice Address - Country:US
Practice Address - Phone:334-466-8225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLN52761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice