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General NPI Number Information
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NPI Number | 1518358951
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Entity Type | Organization
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Legal Business Name | MARK E RONGONE DDS LLC
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Dates
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Enumeration Date | 02/06/2015
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Last Update Date | 02/06/2015
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Provider Practice Location Address
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Address Line | 1109 N MARKET ST
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City | BERWICK
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State | PA
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Zip | 18603-2134
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Country | US
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Telephone | 570-759-9384
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Fax | 570-759-9386
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Provider Business Mailing Address
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Address Line | 1109 N MARKET ST
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City | BERWICK
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State | PA
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Zip | 18603-2134
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Country | US
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Telephone | 570-759-9384
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Fax | 570-759-9386
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK EDWARD RONGONE
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Credential | DDS
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Telephone | 570-759-9384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DS026776L
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License Number State | PA
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