MEDICARE: PAUL R. DONATELLI 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	122300000X	Dentist	DN16240	FL

General Provider Information

NPI Number	:	1699844357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL R. DONATELLI D.M.D.

Provider Business Mailing Address
First Line	:	8519 PORTOBELLO LN
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-8185
Country	:	US
Telephone Number	:	561-625-1016
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 S DIXIE HWY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-4814
Country	:	US
Telephone Number	:	561-586-7502
Fax Number	:	561-547-7661

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

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

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