Provider Demographics
NPI:1912929001
Name:DONLE, EDWARD W (DMD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:W
Last Name:DONLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 MOUNT AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-3924
Mailing Address - Country:US
Mailing Address - Phone:617-923-8159
Mailing Address - Fax:617-923-2016
Practice Address - Street 1:63 MOUNT AUBURN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-3924
Practice Address - Country:US
Practice Address - Phone:617-923-8159
Practice Address - Fax:617-923-2016
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA124331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice