Provider Demographics
NPI:1134335961
Name:VICTOR J DONGO DMD PA
Entity type:Organization
Organization Name:VICTOR J DONGO DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:DONGO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD FAGD
Authorized Official - Phone:305-512-3700
Mailing Address - Street 1:3307 WEST 80TH STREET
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018
Mailing Address - Country:US
Mailing Address - Phone:305-512-3700
Mailing Address - Fax:305-512-8555
Practice Address - Street 1:3307 WEST 80TH STREET
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018
Practice Address - Country:US
Practice Address - Phone:305-512-3700
Practice Address - Fax:305-512-8555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 14564122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty