Provider Demographics
NPI:1699509166
Name:DONASTORG DENTISTRY PLLC
Entity type:Organization
Organization Name:DONASTORG DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DONASTORG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-241-2959
Mailing Address - Street 1:4336 TUPPER LAKE WAY
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48451-8469
Mailing Address - Country:US
Mailing Address - Phone:810-241-2959
Mailing Address - Fax:
Practice Address - Street 1:10192 GRAND RIVER RD STE 104
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-6516
Practice Address - Country:US
Practice Address - Phone:810-227-5136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty