Provider Demographics
NPI:1225257736
Name:RICCIARDI, MARIO JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:JAMES
Last Name:RICCIARDI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8004 HAVEN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3047
Mailing Address - Country:US
Mailing Address - Phone:909-980-6252
Mailing Address - Fax:909-980-6054
Practice Address - Street 1:8004 HAVEN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3047
Practice Address - Country:US
Practice Address - Phone:909-980-6252
Practice Address - Fax:909-980-6054
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA294331223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics