Provider Demographics
NPI:1306075858
Name:PICCIANO, ANTONIO LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:LEE
Last Name:PICCIANO
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 1:6790 PERIMETER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-8063
Mailing Address - Country:US
Mailing Address - Phone:614-717-3500
Mailing Address - Fax:614-717-0933
Practice Address - Street 1:1201 S HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206-3400
Practice Address - Country:US
Practice Address - Phone:614-258-3880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-023063122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2982858Medicaid