Provider Demographics
NPI:1821548108
Name:DINAPOLI DENTAL 1, LLC
Entity Type:Organization
Organization Name:DINAPOLI DENTAL 1, LLC
Other - Org Name:PREMIER DENTAL OF LANCASTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:DINAPOLI
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-203-7629
Mailing Address - Street 1:784 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3983
Mailing Address - Country:US
Mailing Address - Phone:740-687-5811
Mailing Address - Fax:614-321-3992
Practice Address - Street 1:784 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3983
Practice Address - Country:US
Practice Address - Phone:740-687-5811
Practice Address - Fax:614-321-3992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH197411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty