Provider Demographics
NPI:1881896769
Name:DONAHUE DENTAL
Entity type:Organization
Organization Name:DONAHUE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DONAHUE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-946-6117
Mailing Address - Street 1:2020 BLUESTONE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5974
Mailing Address - Country:US
Mailing Address - Phone:636-946-6117
Mailing Address - Fax:636-946-2776
Practice Address - Street 1:1 WESTBURY DR
Practice Address - Street 2:SUITE 240
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2541
Practice Address - Country:US
Practice Address - Phone:636-946-6117
Practice Address - Fax:636-946-2776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty