Provider Demographics
NPI:1346781424
Name:RINALDI FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:RINALDI FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:M
Authorized Official - Last Name:RINALDI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-588-5151
Mailing Address - Street 1:226 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:PA
Mailing Address - Zip Code:18013-2528
Mailing Address - Country:US
Mailing Address - Phone:610-588-5151
Mailing Address - Fax:610-588-6135
Practice Address - Street 1:226 BROADWAY
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:PA
Practice Address - Zip Code:18013-2528
Practice Address - Country:US
Practice Address - Phone:610-588-5151
Practice Address - Fax:610-588-6135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0369611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA20693OtherLICENSE NUMBER
PA1003126392OtherINDIVIDUAL NPI
PA036961OtherLICENSE
PA1851487169OtherINDIVIUAL NPI