Healthcare Provider Details

I. General information

NPI: 1174611610
Provider Name (Legal Business Name): DANIEL E DONOHUE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10640 N RIVERSIDE DR STE 100
FT WORTH TX
76244
US

IV. Provider business mailing address

10640 N RIVERSIDE DR STE 100
FT WORTH TX
76244
US

V. Phone/Fax

Practice location:
  • Phone: 817-431-6008
  • Fax: 817-337-0098
Mailing address:
  • Phone: 817-431-6008
  • Fax: 817-337-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number14921
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: