Provider Demographics
NPI:1659728145
Name:GIONFRIDDO, RILEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:RILEY
Middle Name:
Last Name:GIONFRIDDO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 FARQUHAR ST # 1
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02131-1508
Mailing Address - Country:US
Mailing Address - Phone:860-942-3868
Mailing Address - Fax:
Practice Address - Street 1:60 ADAMS ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-1907
Practice Address - Country:US
Practice Address - Phone:787-843-0660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT157779482122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist