Dentino, Mariellen
Dentino, Mariellen is an individual health care provider with primary practice located at 3801 Bellemeade Ave Ste 330 , Evansville IN 47714-0113. She recently has only one registered license in Allopathic & Osteopathic Physicians / Nephrology, which is considered as her primary health care specialty. Dentino, Mariellen can be contacted via phone (812) 479-3125.Contact Information
Primary practice address
3801 Bellemeade Ave Ste 330
Evansville IN 47714-0113
Phone: (812) 479-3125
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Nephrology | 207RN0300X | 1024941 | Indiana |
Profile Details
| NPI number | 1275533622 |
|---|---|
| LBN Legal business name | Dentino, Mariellen |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 28th, 2005 |
| Last updated | Jun 17th, 2022 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1275533622 | NPPES |
| Indiana | MEDICAID | 100242750 | |
| Indiana | Other | 390004294 |
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