MEDICARE: DR. CARLTON L DONOWA 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	122300000X	Dentist	4819-15	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841287893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLTON L DONOWA DDS

Provider Business Mailing Address
First Line	:	6032 40TH AVE
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53142-7018
Country	:	US
Telephone Number	:	262-656-0764
Fax Number	:	262-656-1833

Provider Business Practice Location Address
First Line	:	3011 90TH ST
Second Line	:
City	:	STURTEVANT
State	:	WI
Zip	:	53177-2714
Country	:	US
Telephone Number	:	262-656-0764
Fax Number	:	262-656-1833

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	04/17/2022

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