Provider Demographics
NPI:1295959021
Name:DONESKY, MELVIN KEITH (DDS)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:KEITH
Last Name:DONESKY
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:PO BOX 684
Mailing Address - Street 2:
Mailing Address - City:NEW TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37824
Mailing Address - Country:US
Mailing Address - Phone:423-626-6565
Mailing Address - Fax:423-626-6556
Practice Address - Street 1:212 FORREST AVE.
Practice Address - Street 2:
Practice Address - City:NEW TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37825
Practice Address - Country:US
Practice Address - Phone:423-626-6565
Practice Address - Fax:423-626-6556
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS004887122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist