Provider Demographics
NPI:1710901038
Name:WALLINGER-CORVINO, DONNA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:M
Last Name:WALLINGER-CORVINO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 SAINT JAMES CT
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-8302
Mailing Address - Country:US
Mailing Address - Phone:610-759-3962
Mailing Address - Fax:
Practice Address - Street 1:477 BUSHKILL PLAZA LN
Practice Address - Street 2:
Practice Address - City:WIND GAP
Practice Address - State:PA
Practice Address - Zip Code:18091-9665
Practice Address - Country:US
Practice Address - Phone:610-863-4692
Practice Address - Fax:610-863-3052
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025903L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice