Healthcare Provider Details

I. General information

NPI: 1841617024
Provider Name (Legal Business Name): ADAM DONNELL D.M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 CHESTNUT ST
NEEDHAM MA
02492-2578
US

IV. Provider business mailing address

87 CHESTNUT ST
NEEDHAM MA
02492-2578
US

V. Phone/Fax

Practice location:
  • Phone: 781-444-6650
  • Fax: 781-444-3607
Mailing address:
  • Phone: 781-444-6650
  • Fax: 781-444-3607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN1856479
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: