Provider Demographics
NPI:1154524775
Name:DINELLA, ODETA (DDS)
Entity type:Individual
Prefix:DR
First Name:ODETA
Middle Name:
Last Name:DINELLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 GLORIA ST
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-4925
Mailing Address - Country:US
Mailing Address - Phone:734-716-2080
Mailing Address - Fax:
Practice Address - Street 1:5556 METRO PKWY STE B
Practice Address - Street 2:
Practice Address - City:STERLING HTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4110
Practice Address - Country:US
Practice Address - Phone:586-939-5980
Practice Address - Fax:586-939-3409
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-10
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019605122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist