Provider Demographics
NPI:1780981142
Name:DONOHUE, STEPHEN JOESPH (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOESPH
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 1:703 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3212
Mailing Address - Country:US
Mailing Address - Phone:703-532-2020
Mailing Address - Fax:703-532-0019
Practice Address - Street 1:703 PARK AVE
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3212
Practice Address - Country:US
Practice Address - Phone:703-532-2020
Practice Address - Fax:703-532-0019
Is Sole Proprietor?:No
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010069871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice