Healthcare Provider Details

I. General information

NPI: 1316040991
Provider Name (Legal Business Name): ERNEST ROBERT TONIELLI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 MAINE ST
QUINCY IL
62301-4483
US

IV. Provider business mailing address

3215 MAINE ST
QUINCY IL
62301-4483
US

V. Phone/Fax

Practice location:
  • Phone: 217-224-2750
  • Fax: 217-224-6990
Mailing address:
  • Phone: 217-224-2750
  • Fax: 217-224-6990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number015550
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: