Provider Demographics
NPI:1952434219
Name:DORNIN, TIMOTHY MANGUS (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MANGUS
Last Name:DORNIN
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 1:1000 COMMERCE DR STE 1005
Mailing Address - Street 2:
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-4739
Mailing Address - Country:US
Mailing Address - Phone:412-264-7200
Mailing Address - Fax:412-264-2426
Practice Address - Street 1:1000 COMMERCE DR STE 1005
Practice Address - Street 2:
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-4739
Practice Address - Country:US
Practice Address - Phone:412-264-7200
Practice Address - Fax:412-264-2426
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-029108-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist