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General NPI Number Information
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NPI Number | 1548472798
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Entity Type | Individual
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Provider Name | DIRK MICHAEL DONOVAN DMD, MSD
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Gender | Male
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6601 S RURAL RD
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City | TEMPE
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State | AZ
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Zip | 85283
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Country | US
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Telephone | 480-756-6522
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Fax |
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Provider Business Mailing Address
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Address Line | 20100 N 78TH PLACE #1196
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City | SCOTTSDALE
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State | AZ
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Zip | 85255
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Country | US
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Telephone | 630-991-7056
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 7911
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License Number State | AZ
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