Provider Demographics
NPI:1083737829
Name:RICCIARDI, PETER LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:LAWRENCE
Last Name:RICCIARDI
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 1:7731 AUTUMN RIDGE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523
Mailing Address - Country:US
Mailing Address - Phone:775-229-8442
Mailing Address - Fax:
Practice Address - Street 1:1055 NORTH HILLS BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506
Practice Address - Country:US
Practice Address - Phone:775-677-1055
Practice Address - Fax:775-677-1081
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV50781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice