Provider Demographics
NPI:1063675791
Name:PENTINO, ALEX MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:MICHAEL
Last Name:PENTINO
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 1:107 PLAZA DR STE F
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-8735
Mailing Address - Country:US
Mailing Address - Phone:740-695-5700
Mailing Address - Fax:740-695-5701
Practice Address - Street 1:3064 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-3721
Practice Address - Country:US
Practice Address - Phone:304-723-5120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV38301223G0001X
OH300227561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice