MEDICARE: DR. ANGELA DONOHUE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	12960	TX

General Provider Information

NPI Number	:	1326055120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA DONOHUE DDS

Provider Business Mailing Address
First Line	:	4151 SOUTHWEST FWY
Second Line	:	450
City	:	HOUSTON
State	:	TX
Zip	:	77027-7312
Country	:	US
Telephone Number	:	713-439-7567
Fax Number	:	713-622-0581

Provider Business Practice Location Address
First Line	:	4151 SOUTHWEST FWY
Second Line	:	450
City	:	HOUSTON
State	:	TX
Zip	:	77027-7312
Country	:	US
Telephone Number	:	713-439-7567
Fax Number	:	713-622-0581

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	07/08/2007

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