Edgar Newton Donahoe III, DMD
Individual provider Active NPI Dentist · Indianola, MS
NPI 1477073278 · NPPES record last updated Jun 16, 2018
Key facts
- NPI
- 1477073278
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 3921-17 (MS)
- Practice address
- 501 Park Ave
Indianola, MS 38751-2355 - Phone
- (662) 887-1272
- NPI assigned
- Jun 22, 2017
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3921-17 | MS | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Dental Care | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 3921-17 | MS | Yes |
Addresses
Primary practice location
501 Park Ave
Indianola, MS 38751-2355
Mailing address
501 Park Ave
Indianola, MS 38751-2355
Phone (662) 887-1272
Other names
- Trey Donahoe
Other providers in Indianola, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 16, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.