Provider Demographics
NPI:1699762062
Name:DINELLO, DOMENIC ANTHONY (DMD)
Entity type:Individual
Prefix:DR
First Name:DOMENIC
Middle Name:ANTHONY
Last Name:DINELLO
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 1:116 EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-1402
Mailing Address - Country:US
Mailing Address - Phone:330-424-9024
Mailing Address - Fax:330-424-5999
Practice Address - Street 1:116 EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-1402
Practice Address - Country:US
Practice Address - Phone:330-424-9024
Practice Address - Fax:330-424-5999
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300206151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2010648Medicaid