Provider Demographics
NPI:1720008733
Name:RIOS, RICARDO I (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:
Last Name:RIOS
Suffix:I
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5392 ROUTE 9W
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-1323
Mailing Address - Country:US
Mailing Address - Phone:845-565-4150
Mailing Address - Fax:845-561-9231
Practice Address - Street 1:5392 ROUTE 9W
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-1323
Practice Address - Country:US
Practice Address - Phone:845-565-4150
Practice Address - Fax:845-561-9231
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0471321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY047132OtherNYS LICENSE