Provider Demographics
NPI:1144237884
Name:TINELLI, WILLIAM C (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:TINELLI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:C
Other - Last Name:TINELLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:215 S MASSEY ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601
Mailing Address - Country:US
Mailing Address - Phone:315-788-3000
Mailing Address - Fax:315-788-6821
Practice Address - Street 1:215 S MASSEY ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601
Practice Address - Country:US
Practice Address - Phone:315-788-3000
Practice Address - Fax:315-788-6821
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0323371122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist