Provider Demographics
NPI:1619232527
Name:DIMEO FAMILY DENTAL, PA
Entity type:Organization
Organization Name:DIMEO FAMILY DENTAL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DIMEO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:772-266-0962
Mailing Address - Street 1:5683 SE CROOKED OAK AVE
Mailing Address - Street 2:SUITE / UNIT 4A
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-8319
Mailing Address - Country:US
Mailing Address - Phone:772-266-0962
Mailing Address - Fax:772-266-0965
Practice Address - Street 1:5683 SE CROOKED OAK AVE
Practice Address - Street 2:SUITE / UNIT 4A
Practice Address - City:HOBE SOUND
Practice Address - State:FL
Practice Address - Zip Code:33455-8319
Practice Address - Country:US
Practice Address - Phone:772-266-0962
Practice Address - Fax:772-266-0965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN185661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty