Provider Demographics
NPI:1194379891
Name:DEMICHELE, DONALD RICHARD II (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:RICHARD
Last Name:DEMICHELE
Suffix:II
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 1:13110 QUARTERHORSE RUN
Mailing Address - Street 2:
Mailing Address - City:ROUGEMONT
Mailing Address - State:NC
Mailing Address - Zip Code:27572-9342
Mailing Address - Country:US
Mailing Address - Phone:208-477-3288
Mailing Address - Fax:
Practice Address - Street 1:BLDG H-3817 GRUBER RD
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-4095
Practice Address - Country:US
Practice Address - Phone:910-396-1572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11389122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist