Provider Demographics
NPI:1124325055
Name:LEMONGELLO, GERARD J JR (DMD)
Entity type:Individual
Prefix:DR
First Name:GERARD
Middle Name:J
Last Name:LEMONGELLO
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5602 PGA BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-3829
Mailing Address - Country:US
Mailing Address - Phone:561-627-9000
Mailing Address - Fax:561-627-9162
Practice Address - Street 1:5602 PGA BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-3829
Practice Address - Country:US
Practice Address - Phone:561-627-9000
Practice Address - Fax:561-627-9162
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN113031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice