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General NPI Number Information
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NPI Number | 1235024720
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Entity Type | Organization
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Legal Business Name | DR ITALO DI PRISCO DDS INC
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Dates
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Enumeration Date | 06/12/2025
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 5080 BRADENTON AVE
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City | DUBLIN
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State | OH
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Zip | 43017-7581
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Country | US
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Telephone | 304-720-7819
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Fax |
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Provider Business Mailing Address
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Address Line | 103 STATION PLACE WAY
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City | HURRICANE
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State | WV
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Zip | 25526-8747
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Country | US
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Telephone | 304-552-7688
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF REVENUE
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Name | LESLEY COYNER
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Credential |
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Telephone | 304-720-7819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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