Provider Demographics
NPI:1548491459
Name:AVOLIO, JOHN DAVID (DMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:AVOLIO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 S MAIN ST
Mailing Address - Street 2:#2103
Mailing Address - City:ZELIENOPLE
Mailing Address - State:PA
Mailing Address - Zip Code:16063-1603
Mailing Address - Country:US
Mailing Address - Phone:724-453-1200
Mailing Address - Fax:724-452-1585
Practice Address - Street 1:506 S MAIN ST
Practice Address - Street 2:#2103
Practice Address - City:ZELIENOPLE
Practice Address - State:PA
Practice Address - Zip Code:16063-1603
Practice Address - Country:US
Practice Address - Phone:724-453-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0230881223G0001X
PADS0378171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice