Provider Demographics
NPI:1013068154
Name:IANNONE, DONNA L (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:L
Last Name:IANNONE
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 1:3582 BRODHEAD RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-3142
Mailing Address - Country:US
Mailing Address - Phone:724-728-5500
Mailing Address - Fax:
Practice Address - Street 1:3582 BRODHEAD RD
Practice Address - Street 2:SUITE 305
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061-3142
Practice Address - Country:US
Practice Address - Phone:724-728-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030581L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010560120001Medicaid
OH2158703Medicaid