Provider Demographics
NPI:1275630873
Name:PLUNKETT, DANE R (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANE
Middle Name:R
Last Name:PLUNKETT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:DANE
Other - Middle Name:R
Other - Last Name:PLUNKETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1234 MAPLE ST EXT
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108
Mailing Address - Country:US
Mailing Address - Phone:412-264-4609
Mailing Address - Fax:
Practice Address - Street 1:1234 MAPLE ST EXT
Practice Address - Street 2:
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108
Practice Address - Country:US
Practice Address - Phone:412-264-4609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS18629L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice