Provider Demographics
NPI:1235385196
Name:DUBANIEWICZ, AMELIA ELIZABETH (DDS)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:ELIZABETH
Last Name:DUBANIEWICZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30539 PINETREE ROAD
Mailing Address - Street 2:SUITE 234
Mailing Address - City:PEPPER PIKE
Mailing Address - State:OH
Mailing Address - Zip Code:44124
Mailing Address - Country:US
Mailing Address - Phone:216-464-7979
Mailing Address - Fax:
Practice Address - Street 1:30539 PINETREE ROAD
Practice Address - Street 2:SUITE 234
Practice Address - City:PEPPER PIKE
Practice Address - State:OH
Practice Address - Zip Code:44124
Practice Address - Country:US
Practice Address - Phone:216-464-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16819122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist