Provider Demographics
NPI:1770534679
Name:SMALDINO, PHILIP BRIAN (DDS)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:BRIAN
Last Name:SMALDINO
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 1:263 W MCKINLEY WAY
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514
Mailing Address - Country:US
Mailing Address - Phone:330-757-2412
Mailing Address - Fax:330-757-2503
Practice Address - Street 1:263 W MCKINLEY WAY
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514
Practice Address - Country:US
Practice Address - Phone:330-757-2412
Practice Address - Fax:330-757-2503
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18108122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist