Provider Demographics
NPI:1073721262
Name:DANIELLO, RALPH V (DDS)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:V
Last Name:DANIELLO
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 1:20 PROSPECT ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-1367
Mailing Address - Country:US
Mailing Address - Phone:518-884-2511
Mailing Address - Fax:
Practice Address - Street 1:20 PROSPECT ST
Practice Address - Street 2:SUITE 204
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-1367
Practice Address - Country:US
Practice Address - Phone:518-884-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0460511223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics