Provider Demographics
NPI:1497720734
Name:PRINCE, DONA W (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONA
Middle Name:W
Last Name:PRINCE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 SERGEANT RD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-4648
Mailing Address - Country:US
Mailing Address - Phone:712-274-2228
Mailing Address - Fax:712-274-1362
Practice Address - Street 1:4220 SERGEANT RD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4648
Practice Address - Country:US
Practice Address - Phone:712-274-2228
Practice Address - Fax:712-274-1362
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA67221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0187153Medicaid
IAU 28616Medicare UPIN