Provider Demographics
NPI:1316040991
Name:TONIELLI, ERNEST ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:ROBERT
Last Name:TONIELLI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4483
Mailing Address - Country:US
Mailing Address - Phone:217-224-2750
Mailing Address - Fax:217-224-6990
Practice Address - Street 1:3215 MAINE ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4483
Practice Address - Country:US
Practice Address - Phone:217-224-2750
Practice Address - Fax:217-224-6990
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO015550122300000X
IL122300000X, 1223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology