Provider Demographics
NPI:1477761278
Name:MASTROIANNI, ERNEST ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:ANTHONY
Last Name:MASTROIANNI
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 1:110 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-3822
Mailing Address - Country:US
Mailing Address - Phone:330-673-7155
Mailing Address - Fax:330-673-0789
Practice Address - Street 1:110 E ELM ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-3822
Practice Address - Country:US
Practice Address - Phone:330-673-7155
Practice Address - Fax:330-673-0789
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300116451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice