Healthcare Provider Details

I. General information

NPI: 1699762062
Provider Name (Legal Business Name): DOMENIC ANTHONY DINELLO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 EXCHANGE ST
LISBON OH
44432-1402
US

IV. Provider business mailing address

116 EXCHANGE ST
LISBON OH
44432-1402
US

V. Phone/Fax

Practice location:
  • Phone: 330-424-9024
  • Fax: 330-424-5999
Mailing address:
  • Phone: 330-424-9024
  • Fax: 330-424-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30020615
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: