Provider Demographics
NPI:1063531747
Name:DONNELLY, TOM (DDS)
Entity type:Individual
Prefix:DR
First Name:TOM
Middle Name:
Last Name:DONNELLY
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 1:7A HEDGEROSE CT
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-1987
Mailing Address - Country:US
Mailing Address - Phone:828-505-0539
Mailing Address - Fax:
Practice Address - Street 1:355 OLD GLENWOOD RD.
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752
Practice Address - Country:US
Practice Address - Phone:828-659-7810
Practice Address - Fax:828-652-3310
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC48951223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health