Provider Demographics
NPI:1235283748
Name:DONAGHY, FREDERICK A (DDS)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:A
Last Name:DONAGHY
Suffix:
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 1:3093 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3151
Mailing Address - Country:US
Mailing Address - Phone:303-443-1703
Mailing Address - Fax:
Practice Address - Street 1:3093 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3151
Practice Address - Country:US
Practice Address - Phone:303-443-1703
Practice Address - Fax:303-545-5324
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1045541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice