Provider Demographics
NPI:1881117356
Name:DONLON, MICAH D (DMD)
Entity type:Individual
Prefix:DR
First Name:MICAH
Middle Name:D
Last Name:DONLON
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 1:740 S LIMESTONE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0001
Mailing Address - Country:US
Mailing Address - Phone:859-323-5500
Mailing Address - Fax:
Practice Address - Street 1:740 S LIMESTONE STE E214
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-323-5500
Practice Address - Fax:859-323-0001
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10818122300000X, 1223X2210X
SC8976122300000X
FLDN25572122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X2210XDental ProvidersDentistOrofacial Pain
No122300000XDental ProvidersDentist