Healthcare Provider Details

I. General information

NPI: 1942387535
Provider Name (Legal Business Name): RICHARD E DONATELLI DMD MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CENTER DR
GAINESVILLE FL
32610-3006
US

IV. Provider business mailing address

1395 CENTER DR
GAINESVILLE FL
32610-3006
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5651
  • Fax: 352-273-5651
Mailing address:
  • Phone: 352-273-5651
  • Fax: 352-273-5651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN15392
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: