Provider Demographics
NPI:1316111875
Name:VANELLA, MARK N (DMD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:N
Last Name:VANELLA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:TARENTUM
Mailing Address - State:PA
Mailing Address - Zip Code:15084-1847
Mailing Address - Country:US
Mailing Address - Phone:724-226-2808
Mailing Address - Fax:724-226-1619
Practice Address - Street 1:415 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:TARENTUM
Practice Address - State:PA
Practice Address - Zip Code:15084-1847
Practice Address - Country:US
Practice Address - Phone:724-226-2808
Practice Address - Fax:724-226-1619
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026730L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice