Provider Demographics
NPI:1396819595
Name:DIGIALLORENZO, DAVID P (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:DIGIALLORENZO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:P
Other - Last Name:DIGIALLORENZO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:184 WEST MAIN STREET
Mailing Address - Street 2:BUILDING 200
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426
Mailing Address - Country:US
Mailing Address - Phone:610-409-6064
Mailing Address - Fax:
Practice Address - Street 1:184 WEST MAIN STREET
Practice Address - Street 2:BUILDING 200
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426
Practice Address - Country:US
Practice Address - Phone:610-409-6064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028559L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics