Provider Demographics
NPI:1982876660
Name:DOMENIC DINELLO DMD, INC.
Entity Type:Organization
Organization Name:DOMENIC DINELLO DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMENIC
Authorized Official - Middle Name:
Authorized Official - Last Name:DINELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:330-652-9845
Mailing Address - Street 1:40 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-5018
Mailing Address - Country:US
Mailing Address - Phone:330-652-9845
Mailing Address - Fax:330-652-2284
Practice Address - Street 1:40 E PARK AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-5018
Practice Address - Country:US
Practice Address - Phone:330-652-9845
Practice Address - Fax:330-652-2284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30020615122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2010648Medicaid