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General NPI Number Information
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NPI Number | 1285652321
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Entity Type | Individual
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Provider Name | ERIC THOMAS MONG DDS
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 05/15/2019
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Provider Practice Location Address
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Address Line | 408 S MAIN ST
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City | GREENVILLE
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State | PA
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Zip | 16125-1773
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Country | US
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Telephone | 724-588-8910
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Fax |
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Provider Business Mailing Address
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Address Line | 10 E GREENVILLE DR
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City | GREENVILLE
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State | PA
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Zip | 16125-8501
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Country | US
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Telephone | 724-588-7853
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS027674L
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License Number State | PA
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