Provider Demographics
NPI:1205240074
Name:ANTONE, MICHAEL ADEL (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ADEL
Last Name:ANTONE
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 1:7697 MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-5540
Mailing Address - Country:US
Mailing Address - Phone:440-530-3500
Mailing Address - Fax:
Practice Address - Street 1:7697 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5540
Practice Address - Country:US
Practice Address - Phone:440-530-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3756-14122300000X
OH30.025335122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist