Provider Demographics
NPI:1639208986
Name:DONAN, GUILLERMO ANTONIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:ANTONIO
Last Name:DONAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E BARSTOW AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5023
Mailing Address - Country:US
Mailing Address - Phone:559-222-9923
Mailing Address - Fax:
Practice Address - Street 1:125 E BARSTOW AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5023
Practice Address - Country:US
Practice Address - Phone:559-222-9923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA467851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice