Provider Demographics
NPI:1053414284
Name:DONNARUMMA, GLEN CARMINE (DDS)
Entity type:Individual
Prefix:DR
First Name:GLEN
Middle Name:CARMINE
Last Name:DONNARUMMA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 YOUNG ST
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-4112
Mailing Address - Country:US
Mailing Address - Phone:716-694-1134
Mailing Address - Fax:716-694-0665
Practice Address - Street 1:711 YOUNG ST
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-4112
Practice Address - Country:US
Practice Address - Phone:716-694-1134
Practice Address - Fax:716-694-0665
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0409771223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery