Provider Demographics
NPI:1235432162
Name:CRIVELLO, ANTONINO (DMD, MS, FRCD(C))
Entity Type:Individual
Prefix:DR
First Name:ANTONINO
Middle Name:
Last Name:CRIVELLO
Suffix:
Gender:M
Credentials:DMD, MS, FRCD(C)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 LOCUST ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-4455
Mailing Address - Country:US
Mailing Address - Phone:626-796-5361
Mailing Address - Fax:626-796-3857
Practice Address - Street 1:747 LOCUST ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-4455
Practice Address - Country:US
Practice Address - Phone:626-796-5361
Practice Address - Fax:626-796-3857
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA598151223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics