Provider Demographics
NPI:1720102304
Name:DR. CARLTON L DONOWA DDS LLC
Entity type:Organization
Organization Name:DR. CARLTON L DONOWA DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLTON
Authorized Official - Middle Name:L
Authorized Official - Last Name:DONOWA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-656-0764
Mailing Address - Street 1:6032 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-7018
Mailing Address - Country:US
Mailing Address - Phone:262-656-0764
Mailing Address - Fax:262-656-1833
Practice Address - Street 1:6032 40TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7018
Practice Address - Country:US
Practice Address - Phone:262-656-0764
Practice Address - Fax:262-656-1833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4819-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty