Provider Demographics
NPI:1770701286
Name:BRIAN J DONLON D D S P C
Entity type:Organization
Organization Name:BRIAN J DONLON D D S P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DONLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-739-0550
Mailing Address - Street 1:44710 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5482
Mailing Address - Country:US
Mailing Address - Phone:586-739-0550
Mailing Address - Fax:
Practice Address - Street 1:44710 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5482
Practice Address - Country:US
Practice Address - Phone:586-739-0550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-22
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAD5435309122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty