Provider Demographics
NPI:1518173129
Name:D'AVELLO, JOSEPH JOHN-NICOLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JOHN-NICOLAS
Last Name:D'AVELLO
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 1:1821 PORTAGE TRL
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1740
Mailing Address - Country:US
Mailing Address - Phone:330-923-3501
Mailing Address - Fax:
Practice Address - Street 1:1821 PORTAGE TRL
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1740
Practice Address - Country:US
Practice Address - Phone:330-923-3501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH-18629122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist