Provider Demographics
NPI:1376984989
Name:DONNELLY, CHRISTINA MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:MARIE
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 PACIFIC AVENUE #300
Mailing Address - Street 2:COMMUNITY HEALTH CARE
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98402
Mailing Address - Country:US
Mailing Address - Phone:253-722-1540
Mailing Address - Fax:253-722-1546
Practice Address - Street 1:10510 GRAVELLY LAKE DRIVE
Practice Address - Street 2:COMMUNITY HEALTH CARE
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499
Practice Address - Country:US
Practice Address - Phone:253-589-7188
Practice Address - Fax:253-722-1546
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARR603844851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice