Provider Demographics
NPI:1215059035
Name:DIMEO, BRIAN JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JOSEPH
Last Name:DIMEO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7659 PELICAN POINTE DR
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-2002
Mailing Address - Country:US
Mailing Address - Phone:315-521-8078
Mailing Address - Fax:
Practice Address - Street 1:200 S CENTRAL BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-8819
Practice Address - Country:US
Practice Address - Phone:315-521-8078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP44261122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN 18566OtherFL LICENSE NUMBER
NYP44261OtherNY STATE PERMIT NUMBER