Provider Demographics
NPI:1821326190
Name:DONLAN, LAURA JEANNE (DDS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JEANNE
Last Name:DONLAN
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 1:7314 N. WILLOW LAKE CT.
Mailing Address - Street 2:SUITE D
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-8289
Mailing Address - Country:US
Mailing Address - Phone:309-692-0175
Mailing Address - Fax:309-692-3139
Practice Address - Street 1:7314 N. WILLOW LAKE CT.
Practice Address - Street 2:SUITE D
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-8289
Practice Address - Country:US
Practice Address - Phone:309-692-0175
Practice Address - Fax:309-692-3139
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILD19-023606122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist