Provider Demographics
NPI:1255355012
Name:TOMASELLI, DANTE (DMD)
Entity type:Individual
Prefix:DR
First Name:DANTE
Middle Name:
Last Name:TOMASELLI
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 1:810 CANTON RD NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7257
Mailing Address - Country:US
Mailing Address - Phone:770-422-5220
Mailing Address - Fax:
Practice Address - Street 1:810 CANTON RD NE
Practice Address - Street 2:SUITE B
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7257
Practice Address - Country:US
Practice Address - Phone:770-422-5220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA108291223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics