Provider Demographics
NPI:1407974421
Name:ANTONINI, JOSEPH H (DDS)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:H
Last Name:ANTONINI
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:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:DALE
Mailing Address - State:IN
Mailing Address - Zip Code:47523
Mailing Address - Country:US
Mailing Address - Phone:812-937-2591
Mailing Address - Fax:812-937-7159
Practice Address - Street 1:421 WEST MEDCALF ST
Practice Address - Street 2:
Practice Address - City:DALE
Practice Address - State:IN
Practice Address - Zip Code:47523
Practice Address - Country:US
Practice Address - Phone:812-937-2591
Practice Address - Fax:812-937-7159
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN6471122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist