Provider Demographics
NPI:1134443153
Name:MEDINGER, DOMINIC J (DDS)
Entity type:Individual
Prefix:
First Name:DOMINIC
Middle Name:J
Last Name:MEDINGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-1533
Mailing Address - Country:US
Mailing Address - Phone:740-532-6003
Mailing Address - Fax:740-532-1157
Practice Address - Street 1:401 CENTER ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1533
Practice Address - Country:US
Practice Address - Phone:740-532-6003
Practice Address - Fax:740-532-1157
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30021476122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2327637Medicaid