Healthcare Provider Details

I. General information

NPI: 1306075858
Provider Name (Legal Business Name): ANTONIO LEE PICCIANO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 12/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S HIGH ST
COLUMBUS OH
43206-3400
US

IV. Provider business mailing address

6790 PERIMETER DR SUITE 100
DUBLIN OH
43016-8063
US

V. Phone/Fax

Practice location:
  • Phone: 614-258-3880
  • Fax:
Mailing address:
  • Phone: 614-717-3500
  • Fax: 614-717-0933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30-023063
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: