Provider Demographics
NPI:1669963369
Name:DONNELLY, DEVAN MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:DEVAN
Middle Name:MARIE
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:DMD
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 368
Mailing Address - Street 2:
Mailing Address - City:ELK POINT
Mailing Address - State:SD
Mailing Address - Zip Code:57025-0368
Mailing Address - Country:US
Mailing Address - Phone:605-356-2271
Mailing Address - Fax:712-276-8403
Practice Address - Street 1:109 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ELK POINT
Practice Address - State:SD
Practice Address - Zip Code:57025-2310
Practice Address - Country:US
Practice Address - Phone:605-356-2271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-095371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDD1201OtherSOUTH DAKOTA DENTAL BOARD
IADDS-09537OtherIOWA DENTAL BOARD