Provider Demographics
NPI:1144310467
Name:MONGIOVI, VINCENT D (DMD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:D
Last Name:MONGIOVI
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 1:4 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-8117
Mailing Address - Country:US
Mailing Address - Phone:610-358-5003
Mailing Address - Fax:
Practice Address - Street 1:4 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-8117
Practice Address - Country:US
Practice Address - Phone:610-358-5003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031038L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics