Provider Demographics
NPI:1396863379
Name:RICCIARDIELLO, LOUIS (DMD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:
Last Name:RICCIARDIELLO
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 1:96 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-3537
Mailing Address - Country:US
Mailing Address - Phone:603-527-1700
Mailing Address - Fax:603-527-1785
Practice Address - Street 1:96 HIGH ST
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3537
Practice Address - Country:US
Practice Address - Phone:603-527-1700
Practice Address - Fax:603-527-1785
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist