Provider Demographics
NPI:1497838452
Name:DONAHER, DENNIS J (DMD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:J
Last Name:DONAHER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 PANORAMA TRL
Mailing Address - Street 2:SUITE 11
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2406
Mailing Address - Country:US
Mailing Address - Phone:585-586-3290
Mailing Address - Fax:
Practice Address - Street 1:675 PANORAMA TRL
Practice Address - Street 2:SUITE 11
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2406
Practice Address - Country:US
Practice Address - Phone:585-586-3290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0360601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice