Provider Demographics
NPI:1487359063
Name:DECHELLIS, DANTE MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:DANTE
Middle Name:MICHAEL
Last Name:DECHELLIS
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 1:8057 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5830
Mailing Address - Country:US
Mailing Address - Phone:330-261-7586
Mailing Address - Fax:
Practice Address - Street 1:1001 COVINGTON ST
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44510-1617
Practice Address - Country:US
Practice Address - Phone:330-480-3195
Practice Address - Fax:330-480-1366
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRES.0045841223G0001X
OH30.0275761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice