Provider Demographics
NPI:1518358951
Name:MARK E RONGONE DDS LLC
Entity type:Organization
Organization Name:MARK E RONGONE DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:RONGONE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:570-759-9384
Mailing Address - Street 1:1109 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-2134
Mailing Address - Country:US
Mailing Address - Phone:570-759-9384
Mailing Address - Fax:570-759-9386
Practice Address - Street 1:1109 N MARKET ST
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-2134
Practice Address - Country:US
Practice Address - Phone:570-759-9384
Practice Address - Fax:570-759-9386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026776L261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental