Provider Demographics
NPI:1508073966
Name:DONATELLI, HERMAN A (DMD)
Entity Type:Individual
Prefix:DR
First Name:HERMAN
Middle Name:A
Last Name:DONATELLI
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:PO BOX 387
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30085-0387
Mailing Address - Country:US
Mailing Address - Phone:678-612-3001
Mailing Address - Fax:
Practice Address - Street 1:3535 PIEDMONT RD NE STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305
Practice Address - Country:US
Practice Address - Phone:404-816-9665
Practice Address - Fax:404-816-0950
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA88521223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty