Individual
KENNETH DONAHUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1517 PACKER AVENUE, PHILADELPHIA, PA 19145
(215) 462-2424
(215) 271-2915
Mailing address
1517 PACKER AVE, PHILADELPHIA, PA 19145-4910
(215) 462-2424
(215) 271-2915
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS025750L
PA
Other
Enumeration date
04/13/2016
Last updated
04/13/2016
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