Provider Demographics
NPI:1306930169
Name:ADORNATO, DOMINICK CARMEN III (DDS)
Entity type:Individual
Prefix:DR
First Name:DOMINICK
Middle Name:CARMEN
Last Name:ADORNATO
Suffix:III
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 1:1129 EAST AURORA RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056
Mailing Address - Country:US
Mailing Address - Phone:330-468-1188
Mailing Address - Fax:330-468-0464
Practice Address - Street 1:1129 EAST AURORA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056
Practice Address - Country:US
Practice Address - Phone:330-468-1188
Practice Address - Fax:330-468-0464
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH193511223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0107646Medicaid
000000138638OtherANTHEM
U61153Medicare UPIN
000000138638OtherANTHEM