Provider Demographics
NPI:1235681420
Name:ZELIENOPLE SMILES, FAMILY AND IMPLANT DENTISTRY, LLC
Entity Type:Organization
Organization Name:ZELIENOPLE SMILES, FAMILY AND IMPLANT DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:AVOLIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-422-7761
Mailing Address - Street 1:506 S MAIN ST
Mailing Address - Street 2:SUITE 2103
Mailing Address - City:ZELIENOPLE
Mailing Address - State:PA
Mailing Address - Zip Code:16063-1603
Mailing Address - Country:US
Mailing Address - Phone:724-453-1200
Mailing Address - Fax:724-452-1585
Practice Address - Street 1:506 S MAIN ST
Practice Address - Street 2:SUITE 2103
Practice Address - City:ZELIENOPLE
Practice Address - State:PA
Practice Address - Zip Code:16063-1603
Practice Address - Country:US
Practice Address - Phone:724-453-1200
Practice Address - Fax:724-452-1585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037817261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental