Provider Demographics
NPI:1619400181
Name:DONOHUE, BRIANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIANNE
Middle Name:
Last Name:DONOHUE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 WILLOW CT
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4538
Mailing Address - Country:US
Mailing Address - Phone:732-939-1210
Mailing Address - Fax:
Practice Address - Street 1:60 WILLOW CT
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4538
Practice Address - Country:US
Practice Address - Phone:732-939-1210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02663700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist