Provider Demographics
NPI:1114268711
Name:DONOHUE, ELLEN (DDS, AEGD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:DONOHUE
Suffix:
Gender:F
Credentials:DDS, AEGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10998 OMALLEY CENTRE DR STE A
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3168
Mailing Address - Country:US
Mailing Address - Phone:907-561-5154
Mailing Address - Fax:
Practice Address - Street 1:10998 OMALLEY CENTRE DR STE A
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3168
Practice Address - Country:US
Practice Address - Phone:907-561-5154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK119660122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist