Provider Demographics
NPI:1679690036
Name:DR. DAVID J. MONDOCK DMD PC
Entity Type:Organization
Organization Name:DR. DAVID J. MONDOCK DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:MONDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-925-6816
Mailing Address - Street 1:621 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:15697-1112
Mailing Address - Country:US
Mailing Address - Phone:724-925-6816
Mailing Address - Fax:724-925-1357
Practice Address - Street 1:621 S 5TH ST
Practice Address - Street 2:
Practice Address - City:YOUNGWOOD
Practice Address - State:PA
Practice Address - Zip Code:15697-1112
Practice Address - Country:US
Practice Address - Phone:724-925-6816
Practice Address - Fax:724-925-1357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026883L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty