Provider Demographics
NPI:1578612800
Name:BOUNDY, DONNA J (DMD MS)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:J
Last Name:BOUNDY
Suffix:
Gender:F
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:GIBSON CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60936
Mailing Address - Country:US
Mailing Address - Phone:217-784-4550
Mailing Address - Fax:217-784-4580
Practice Address - Street 1:627 E 8TH ST
Practice Address - Street 2:
Practice Address - City:GIBSON CITY
Practice Address - State:IL
Practice Address - Zip Code:60936
Practice Address - Country:US
Practice Address - Phone:217-784-4550
Practice Address - Fax:217-784-4580
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics