Provider Demographics
NPI:1629365846
Name:RAIO DENTAL, PC
Entity Type:Organization
Organization Name:RAIO DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-447-8073
Mailing Address - Street 1:1739 N OCEAN AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-2683
Mailing Address - Country:US
Mailing Address - Phone:631-447-8073
Mailing Address - Fax:631-447-8026
Practice Address - Street 1:1739 N OCEAN AVE
Practice Address - Street 2:SUITE D
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-2683
Practice Address - Country:US
Practice Address - Phone:631-447-8073
Practice Address - Fax:631-447-8026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0465551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01693241Medicaid