Healthcare Provider Details

I. General information

NPI: 1972722866
Provider Name (Legal Business Name): PATRICK J DONOVAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

749 UNIVERSITY ROW
MADISON WI
53705
US

IV. Provider business mailing address

749 UNIVERSITY ROW
MADISON WI
53705
US

V. Phone/Fax

Practice location:
  • Phone: 608-238-7112
  • Fax: 608-238-1061
Mailing address:
  • Phone: 608-238-7112
  • Fax: 608-238-1061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5850-015
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5850
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: