Individual
DR. AMANDA R DONNELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
742 GRAHAM RD, CUYAHOGA FALLS, OH 44221-1055
(330) 929-2616
(330) 929-2636
Mailing address
160 MEADOW LN, PENINSULA, OH 44264-9792
(330) 928-0616
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
21342
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01496920
UNITED CONCORDIA PROVIDER
OH
Enumeration date
10/03/2006
Last updated
07/08/2007
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