Provider Demographics
NPI:1447396577
Name:TONELLI, RICHARD R (DDS)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:R
Last Name:TONELLI
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 1:2805 LIBAL ST # B
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-2877
Mailing Address - Country:US
Mailing Address - Phone:920-339-9013
Mailing Address - Fax:920-339-5741
Practice Address - Street 1:2805 LIBAL ST # B
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2877
Practice Address - Country:US
Practice Address - Phone:920-339-9013
Practice Address - Fax:920-339-5741
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1268 G1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice