Provider Demographics
NPI:1568636272
Name:DONALD K NANNEY DDS PC
Entity type:Organization
Organization Name:DONALD K NANNEY DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:K
Authorized Official - Last Name:NANNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-625-5511
Mailing Address - Street 1:5770 S MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2982
Mailing Address - Country:US
Mailing Address - Phone:248-625-5511
Mailing Address - Fax:248-625-7517
Practice Address - Street 1:5770 S MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2982
Practice Address - Country:US
Practice Address - Phone:248-625-5511
Practice Address - Fax:248-625-7517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI10562122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty