Provider Demographics
NPI:1790423762
Name:ALEX M. PENTINO D.D.S., INC.
Entity type:Organization
Organization Name:ALEX M. PENTINO D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-266-3495
Mailing Address - Street 1:48258 NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-9705
Mailing Address - Country:US
Mailing Address - Phone:740-695-5700
Mailing Address - Fax:740-695-5701
Practice Address - Street 1:48258 NATIONAL RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-9705
Practice Address - Country:US
Practice Address - Phone:740-695-5700
Practice Address - Fax:740-695-5701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3001432Medicaid
1063675791OtherPROVIDER NPI NUMBER
OH30-022756OtherDENTAL LICENSE NUMBER
WV3830OtherDENTAL LICENSE NUMBER