Provider Demographics
NPI:1376727222
Name:FANELLI, DONALD ANTHONY (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ANTHONY
Last Name:FANELLI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 FRANKLIN PLACE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-1707
Mailing Address - Country:US
Mailing Address - Phone:201-460-0820
Mailing Address - Fax:201-460-1272
Practice Address - Street 1:19 FRANKLIN PLACE
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-1707
Practice Address - Country:US
Practice Address - Phone:201-460-0820
Practice Address - Fax:201-460-1272
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01210500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist