Provider Demographics
NPI:1407525769
Name:MCMONAGLE, KELLY MARIA (DMD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:MARIA
Last Name:MCMONAGLE
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 1:269 BICKLEY RD
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-4401
Mailing Address - Country:US
Mailing Address - Phone:484-744-8640
Mailing Address - Fax:
Practice Address - Street 1:886 PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2748
Practice Address - Country:US
Practice Address - Phone:610-223-7777
Practice Address - Fax:610-929-1110
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0444581223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty