Provider Demographics
NPI:1316038300
Name:IANNACCONE, BRIAN JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JOHN
Last Name:IANNACCONE
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 1:90 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14622-1018
Mailing Address - Country:US
Mailing Address - Phone:585-544-3458
Mailing Address - Fax:
Practice Address - Street 1:8 UNION ST
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-1920
Practice Address - Country:US
Practice Address - Phone:585-637-6550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0304081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice