Provider Demographics
NPI:1598851511
Name:IANNELLO, ROBERT RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RICHARD
Last Name:IANNELLO
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 1:23940 IRONWOOD AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-7154
Mailing Address - Country:US
Mailing Address - Phone:951-242-4000
Mailing Address - Fax:951-242-0511
Practice Address - Street 1:23940 IRONWOOD AVE
Practice Address - Street 2:SUITE C
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-7154
Practice Address - Country:US
Practice Address - Phone:951-242-4000
Practice Address - Fax:951-242-0511
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33101122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist