MEDICARE: JAMES B. DONAGHEY II D.M.D.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	3753	AL

General Provider Information

NPI Number	:	1528139904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES B. DONAGHEY II D.M.D.

Provider Business Mailing Address
First Line	:	4626 BIT AND SPUR RD
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36608-2646
Country	:	US
Telephone Number	:	251-342-3188
Fax Number	:	251-342-3526

Provider Business Practice Location Address
First Line	:	4626 BIT AND SPUR RD
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36608-2646
Country	:	US
Telephone Number	:	251-342-3188
Fax Number	:	251-342-3526

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

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	07/08/2007

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