Healthcare Provider Details

I. General information

NPI: 1881117356
Provider Name (Legal Business Name): MICAH D DONLON DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE STE E214
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

740 S LIMESTONE
LEXINGTON KY
40536-0001
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5500
  • Fax: 859-323-0001
Mailing address:
  • Phone: 859-323-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10818
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number8976
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN25572
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number10818
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: