Provider Demographics
NPI:1861497091
Name:DONOHUE, RICHARD F (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:F
Last Name:DONOHUE
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 1:10529 BRADDOCK RD
Mailing Address - Street 2:STE A
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-2245
Mailing Address - Country:US
Mailing Address - Phone:703-250-2970
Mailing Address - Fax:703-503-2817
Practice Address - Street 1:10529 BRADDOCK RD
Practice Address - Street 2:STE A
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-2245
Practice Address - Country:US
Practice Address - Phone:703-250-2970
Practice Address - Fax:703-503-2817
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010046261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice