Provider Demographics
NPI:1578671574
Name:LANAHAN, DONALD JEROME (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JEROME
Last Name:LANAHAN
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 1:824 NE A ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-2212
Mailing Address - Country:US
Mailing Address - Phone:541-476-4583
Mailing Address - Fax:541-479-1515
Practice Address - Street 1:824 NE A ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-2212
Practice Address - Country:US
Practice Address - Phone:541-476-4583
Practice Address - Fax:541-479-1515
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD68041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice