Healthcare Provider Details

I. General information

NPI: 1023113875
Provider Name (Legal Business Name): DONIHUE WATERS DDS MDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 WHITE BLUFF RD SUITE 104
SAVANNAH GA
31406
US

IV. Provider business mailing address

9100 WHITE BLUFF RD SUITE 104
SAVANNAH GA
31406
US

V. Phone/Fax

Practice location:
  • Phone: 912-354-3474
  • Fax: 912-354-7438
Mailing address:
  • Phone: 912-354-3474
  • Fax: 912-354-7438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN012296
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: