MEDICARE: JAMES R DONLEY DDS PLC

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	9163	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9163	OTHER	MI	DENTAL LICENSE
2	1841599230	OTHER		NPI TYPE II
3	1528012697	OTHER		NPI TYPE 1

General Provider Information

NPI Number	:	1841599230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES R DONLEY DDS PLC

Provider Business Mailing Address
First Line	:	166 N CAUSEWAY ST
Second Line	:
City	:	N MUSKEGON
State	:	MI
Zip	:	49445-3302
Country	:	US
Telephone Number	:	231-744-6661
Fax Number	:	231-744-2837

Provider Business Practice Location Address
First Line	:	166 N CAUSEWAY ST
Second Line	:
City	:	N MUSKEGON
State	:	MI
Zip	:	49445-3302
Country	:	US
Telephone Number	:	231-744-6661
Fax Number	:	231-744-2837

Authorized Official
Title or Position	:	MANAGER/DENTIST
Name	:	DR. JAMES RUSSELL DONLEY
Credential	:	DDS
Telephone Number	:	231-744-6661

Provider Enumeration Date	:	03/24/2011
Last Update Date	:	08/19/2015

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