Provider Demographics
NPI:1699282939
Name:CROGNALE FAMILY DENTISTRY
Entity type:Organization
Organization Name:CROGNALE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CROGNALE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-898-6068
Mailing Address - Street 1:2958 MARIETTA AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2126
Mailing Address - Country:US
Mailing Address - Phone:717-898-6068
Mailing Address - Fax:717-898-4672
Practice Address - Street 1:2958 MARIETTA AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2126
Practice Address - Country:US
Practice Address - Phone:717-898-6068
Practice Address - Fax:717-898-4672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037515261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental