Provider Demographics
NPI:1457453276
Name:FANNING, DONALD EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:EDWARD
Last Name:FANNING
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 1:4104 E STAN SCHLUETER LOOP
Mailing Address - Street 2:SUITE 4
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-7872
Mailing Address - Country:US
Mailing Address - Phone:254-690-3600
Mailing Address - Fax:254-690-3639
Practice Address - Street 1:4104 E STAN SCHLUETER LOOP
Practice Address - Street 2:SUITE 4
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-7872
Practice Address - Country:US
Practice Address - Phone:254-690-3600
Practice Address - Fax:254-690-3639
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX147471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice