Provider Demographics
NPI:1457386948
Name:DENGEL, EDWARD JOHN (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JOHN
Last Name:DENGEL
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 1:20455 ROUTE 19
Mailing Address - Street 2:EXCEL CENTRE PLAZA SUITE 12
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-7516
Mailing Address - Country:US
Mailing Address - Phone:724-776-4105
Mailing Address - Fax:
Practice Address - Street 1:20455 ROUTE 19
Practice Address - Street 2:EXCEL CENTRE PLAZA SUITE 12
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-7516
Practice Address - Country:US
Practice Address - Phone:724-776-4105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-019527L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist