1508085234 NPI number — DR. GREGORY SCOTT DONEFF D.D.S.

Table of content: DR. GREGORY SCOTT DONEFF D.D.S. (NPI 1508085234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508085234 NPI number — DR. GREGORY SCOTT DONEFF D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONEFF
Provider First Name:
GREGORY
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508085234
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3166 HUDSON POND LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30062-6697
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-579-8681
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 ASHFORD CTR N
Provider Second Line Business Practice Location Address:
SUITE 330
Provider Business Practice Location Address City Name:
DUNWOODY
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30338-2668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-396-1188
Provider Business Practice Location Address Fax Number:
770-396-6055
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DN013356 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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