Provider Demographics
NPI:1649397886
Name:GOTTWALD, DONNA JANE (DDS)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JANE
Last Name:GOTTWALD
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 1:12740 BANDERA RD
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4327
Mailing Address - Country:US
Mailing Address - Phone:210-695-1200
Mailing Address - Fax:210-695-1370
Practice Address - Street 1:12740 BANDERA RD
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4327
Practice Address - Country:US
Practice Address - Phone:210-695-1200
Practice Address - Fax:210-695-1370
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX185091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice