Provider Demographics
NPI:1548560303
Name:DEPEW, DONALD DOUGLAS (DMD MS PC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:DOUGLAS
Last Name:DEPEW
Suffix:
Gender:M
Credentials:DMD MS PC
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Mailing Address - Street 1:2748 WATTS DR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-2721
Mailing Address - Country:US
Mailing Address - Phone:770-422-3939
Mailing Address - Fax:770-422-5513
Practice Address - Street 1:2748 WATTS DR NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-2721
Practice Address - Country:US
Practice Address - Phone:770-422-3939
Practice Address - Fax:770-422-5513
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA106711223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics