MEDICARE: DR. TINA ANN DONAHUE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	34525	CA

General Provider Information

NPI Number	:	1285725978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TINA ANN DONAHUE DDS

Provider Business Mailing Address
First Line	:	1475 HUNTINGTON AVE STE 315
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-5967
Country	:	US
Telephone Number	:	650-583-7575
Fax Number	:	650-583-7576

Provider Business Practice Location Address
First Line	:	1475 HUNTINGTON AVE STE 315
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-5967
Country	:	US
Telephone Number	:	650-583-7575
Fax Number	:	650-583-7576

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/08/2007

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