Provider Demographics
NPI:1093785511
Name:DINELLO, DONALD J (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:J
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 1:5690 ALLENTOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-4046
Mailing Address - Country:US
Mailing Address - Phone:717-526-2000
Mailing Address - Fax:717-526-0111
Practice Address - Street 1:5690 ALLENTOWN BLVD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112
Practice Address - Country:US
Practice Address - Phone:717-526-2000
Practice Address - Fax:717-526-0111
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030841L1223G0001X
PADA030841A1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA172226Medicare ID - Type Unspecified
PAU75062Medicare UPIN