Provider Demographics
NPI:1295980894
Name:DIGEROLAMO, DANA MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:MARIE
Last Name:DIGEROLAMO
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 1:357 S GULPH RD
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3136
Mailing Address - Country:US
Mailing Address - Phone:917-599-6406
Mailing Address - Fax:610-487-0037
Practice Address - Street 1:357 S GULPH RD
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406
Practice Address - Country:US
Practice Address - Phone:917-599-6406
Practice Address - Fax:610-487-0037
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLL610122300000X
NJ22DI025333001223P0221X
PADS0377001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102851990Medicaid
MD119591300Medicaid