Provider Demographics
NPI:1477763944
Name:RELLE, ATTILA T (DMD)
Entity Type:Individual
Prefix:DR
First Name:ATTILA
Middle Name:T
Last Name:RELLE
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 1:2818 SWANSEA RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-1754
Mailing Address - Country:US
Mailing Address - Phone:614-527-9797
Mailing Address - Fax:614-527-9797
Practice Address - Street 1:2818 SWANSEA RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-1754
Practice Address - Country:US
Practice Address - Phone:614-527-9797
Practice Address - Fax:614-527-9797
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30018067122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0606704Medicaid