Provider Demographics
NPI:1740801224
Name:MINNILLO & MARSHALL GENERAL DENTISTS
Entity type:Organization
Organization Name:MINNILLO & MARSHALL GENERAL DENTISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MINNILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-452-5144
Mailing Address - Street 1:1212 ABBE RD N STE E
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-1600
Mailing Address - Country:US
Mailing Address - Phone:440-525-5144
Mailing Address - Fax:440-366-6311
Practice Address - Street 1:420 MAIN ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:OH
Practice Address - Zip Code:44044-1206
Practice Address - Country:US
Practice Address - Phone:440-926-3441
Practice Address - Fax:440-926-3885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty