Provider Demographics
NPI:1235426834
Name:RICCIARDONE, JOSHUA (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:RICCIARDONE
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 1:5300 OVERLOOK RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36618-2331
Mailing Address - Country:US
Mailing Address - Phone:251-342-6672
Mailing Address - Fax:337-886-6348
Practice Address - Street 1:5300 OVERLOOK RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36618-2331
Practice Address - Country:US
Practice Address - Phone:251-342-6672
Practice Address - Fax:251-342-6703
Is Sole Proprietor?:No
Enumeration Date:2011-07-02
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL63511223G0001X
LA6200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1862002Medicaid