Provider Demographics
NPI:1417063280
Name:NIEMANN, DONALD EDWARD (DDS)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:EDWARD
Last Name:NIEMANN
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 1:408 LILLY RD NE STE B
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-6954
Mailing Address - Country:US
Mailing Address - Phone:360-459-5900
Mailing Address - Fax:360-459-8720
Practice Address - Street 1:408 LILLY RD NE STE B
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-6954
Practice Address - Country:US
Practice Address - Phone:360-459-5900
Practice Address - Fax:360-459-8720
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA43841223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics