Provider Demographics
NPI:1437195443
Name:RIDOLFO, BRUCE T (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:T
Last Name:RIDOLFO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:124 RIVERMIST DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-4300
Mailing Address - Country:US
Mailing Address - Phone:716-854-1270
Mailing Address - Fax:
Practice Address - Street 1:6576 E QUAKER ST
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2502
Practice Address - Country:US
Practice Address - Phone:716-662-9341
Practice Address - Fax:716-662-0317
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0384421223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery