Provider Demographics
NPI:1437165255
Name:RAINALDI, LIDIO GREGORIO JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:LIDIO
Middle Name:GREGORIO
Last Name:RAINALDI
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:501 NIZHONI BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301
Mailing Address - Country:US
Mailing Address - Phone:505-863-9363
Mailing Address - Fax:505-863-2554
Practice Address - Street 1:501 NIZHONI BLVD
Practice Address - Street 2:STE A
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301
Practice Address - Country:US
Practice Address - Phone:505-863-9363
Practice Address - Fax:505-863-2554
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMNM1449122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist