Provider Demographics
NPI:1356358188
Name:DONGELL, EDWARD JOSEPH (DMD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JOSEPH
Last Name:DONGELL
Suffix:
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 1:520 CHURCH ST SUITE 3
Mailing Address - Street 2:
Mailing Address - City:LILLY
Mailing Address - State:PA
Mailing Address - Zip Code:15938
Mailing Address - Country:US
Mailing Address - Phone:814-886-5713
Mailing Address - Fax:814-886-8713
Practice Address - Street 1:520 CHURCH ST SUITE 3
Practice Address - Street 2:
Practice Address - City:LILLY
Practice Address - State:PA
Practice Address - Zip Code:15938
Practice Address - Country:US
Practice Address - Phone:814-886-5713
Practice Address - Fax:814-886-8713
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAD5021424L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007730140002Medicaid