Provider Demographics
NPI:1730144452
Name:ALONGE, JOHN LAWRENCE (MS, DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LAWRENCE
Last Name:ALONGE
Suffix:
Gender:M
Credentials:MS, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2620
Mailing Address - Country:US
Mailing Address - Phone:814-453-4491
Mailing Address - Fax:814-456-1481
Practice Address - Street 1:316 W 23RD ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2620
Practice Address - Country:US
Practice Address - Phone:814-453-4491
Practice Address - Fax:814-456-1481
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024128L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU49484Medicare UPIN
PAAL769188Medicare ID - Type Unspecified