Provider Demographics
NPI:1225242506
Name:DONNELLY, ANN M (DDS)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:M
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MERCEDES WAY
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-2729
Mailing Address - Country:US
Mailing Address - Phone:415-334-9569
Mailing Address - Fax:
Practice Address - Street 1:1 DANIEL BURNHAM COURT
Practice Address - Street 2:SUITE 1200
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109
Practice Address - Country:US
Practice Address - Phone:415-567-3580
Practice Address - Fax:415-567-3582
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA535911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice