Healthcare Provider Details

I. General information

NPI: 1457255432
Provider Name (Legal Business Name): GLENSIDE ORTHODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 GREENWOOD AVE
WYNCOTE PA
19095-1825
US

IV. Provider business mailing address

400 GREENWOOD AVE
WYNCOTE PA
19095-1825
US

V. Phone/Fax

Practice location:
  • Phone: 267-735-2770
  • Fax: 267-735-2779
Mailing address:
  • Phone: 267-735-2770
  • Fax: 267-735-2779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. KELLY MCMONAGLE
Title or Position: OWNER/ ORTHODONTICS
Credential: DMD, MSD
Phone: 484-744-8640