Provider Demographics
NPI:1083767396
Name:LAURA J DONLAN DDS PC
Entity Type:Organization
Organization Name:LAURA J DONLAN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DONLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:309-692-0175
Mailing Address - Street 1:7314 N WILLOWLAKE COURT
Mailing Address - Street 2:SUITE D
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614
Mailing Address - Country:US
Mailing Address - Phone:309-692-0175
Mailing Address - Fax:309-692-3139
Practice Address - Street 1:7314 N WILLOWLAKE COURT
Practice Address - Street 2:SUITE D
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614
Practice Address - Country:US
Practice Address - Phone:309-692-0175
Practice Address - Fax:309-692-3139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190236061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty