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General NPI Number Information
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NPI Number | 1164563367
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Entity Type | Individual
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Provider Name | MARIETTA DONAHUE DDS
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Gender | Female
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 21 NO BURLINGTON RD SOUTHWOOD STATE PRISON ALLCARE
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City | BRIDGETON
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State | NJ
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Zip | 08302
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Country | US
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Telephone | 856-459-7206
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Fax |
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Provider Business Mailing Address
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Address Line | 10 DICKANS LANE
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City | MT LAUREL
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State | NJ
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Zip | 08054
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Country | US
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Telephone | 856-727-1370
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 220101238000
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License Number State | NJ
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