Healthcare Provider Details

I. General information

NPI: 1326118233
Provider Name (Legal Business Name): WASHTENAW DENTAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WASHTENAW AVE
YPSILANTI MI
48197
US

IV. Provider business mailing address

2100 WASHTENAW AVE
YPSILANTI MI
48197
US

V. Phone/Fax

Practice location:
  • Phone: 734-485-4600
  • Fax: 734-485-4601
Mailing address:
  • Phone: 734-485-4600
  • Fax: 734-485-4601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2901018693
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901012331
License Number StateMI

VIII. Authorized Official

Name: DR. DENNIS G DONOHO
Title or Position: OWNER DENTIST
Credential:
Phone: 734-485-4600