Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 3713 | VA |
NPI | 1013010065 |
---|---|
Provider Name | Dr. James John Donahue JR. |
First Address | Alexandria, VA 22302-2607 |
Second Address | Alexandria, VA 22302-2607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 08/07/2007 |