Provider Demographics
NPI:1487222337
Name:DONNELLY, PATRICK EUGENE (DMD, PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:EUGENE
Last Name:DONNELLY
Suffix:
Gender:M
Credentials:DMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MEADOW SPRING RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-6935
Mailing Address - Country:US
Mailing Address - Phone:724-832-1835
Mailing Address - Fax:
Practice Address - Street 1:105 MEADOW SPRING RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6935
Practice Address - Country:US
Practice Address - Phone:724-832-1835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2022-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0431571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice