Provider Demographics
NPI:1750383550
Name:TOLENTINO, DAVID DELEON (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:DELEON
Last Name:TOLENTINO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 TILGHMAN DR STE 100
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-6699
Mailing Address - Country:US
Mailing Address - Phone:910-892-1091
Mailing Address - Fax:910-892-1097
Practice Address - Street 1:803 TILGHMAN DR STE 100
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334
Practice Address - Country:US
Practice Address - Phone:910-892-1091
Practice Address - Fax:910-892-1097
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2025-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008518207R00000X
NC2016-00627207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2569760Medicaid
OHP00229122OtherRR MEDICARE
OH2569760Medicaid
OH4161585Medicare PIN