Provider Demographics
NPI:1730292111
Name:JANKIEWICZ, DONNA M (DMD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:M
Last Name:JANKIEWICZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W LANCASTER AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DEVON
Mailing Address - State:PA
Mailing Address - Zip Code:19333-1531
Mailing Address - Country:US
Mailing Address - Phone:610-254-9575
Mailing Address - Fax:610-254-9576
Practice Address - Street 1:400 W LANCASTER AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:DEVON
Practice Address - State:PA
Practice Address - Zip Code:19333-1531
Practice Address - Country:US
Practice Address - Phone:610-254-9575
Practice Address - Fax:610-254-9576
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS26249L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist