Provider Demographics
NPI:1508235276
Name:DONGO, VICTOR J (DMD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:J
Last Name:DONGO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3307 W 80TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-5000
Mailing Address - Country:US
Mailing Address - Phone:305-512-3700
Mailing Address - Fax:
Practice Address - Street 1:3307 W 80TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-5000
Practice Address - Country:US
Practice Address - Phone:305-512-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14564122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist