Provider Demographics
NPI:1831402890
Name:LINEBERRY, DONALD EDGAR (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:EDGAR
Last Name:LINEBERRY
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 1:711-B MILNER DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410
Mailing Address - Country:US
Mailing Address - Phone:336-292-6840
Mailing Address - Fax:336-292-6842
Practice Address - Street 1:711-B MILNER DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410
Practice Address - Country:US
Practice Address - Phone:336-292-6840
Practice Address - Fax:336-292-6842
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice