Healthcare Provider Details

I. General information

NPI: 1609109529
Provider Name (Legal Business Name): DIANA MARIE DONGELL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 SUNSET BLVD STE 100
WEST COLUMBIA SC
29169-3494
US

IV. Provider business mailing address

159 STERLING LAKE DR
LEXINGTON SC
29072-8225
US

V. Phone/Fax

Practice location:
  • Phone: 803-386-7442
  • Fax:
Mailing address:
  • Phone: 412-897-7940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDS037147
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN001316
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number9984
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: