MEDICARE: ANTHONY DINAPOLI DDS III CONONIAL DENTAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30019741	OH

General Provider Information

NPI Number	:	1568833788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTHONY DINAPOLI DDS III CONONIAL DENTAL GROUP

Provider Business Mailing Address
First Line	:	3158 E BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43209-2055
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3158 E BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43209-2055
Country	:	US
Telephone Number	:	614-231-6872
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANTHONY DINAPOLI
Credential	:
Telephone Number	:	614-231-6872

Provider Enumeration Date	:	10/14/2015
Last Update Date	:	10/14/2015

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