Provider Demographics
NPI:1730305491
Name:RICCIARDI, GERRI (DMD)
Entity Type:Individual
Prefix:DR
First Name:GERRI
Middle Name:
Last Name:RICCIARDI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:GERALDINE
Other - Middle Name:K
Other - Last Name:RICCIARDI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:210 MOUNTAIN BLVD.
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069
Mailing Address - Country:US
Mailing Address - Phone:908-754-2200
Mailing Address - Fax:908-754-0140
Practice Address - Street 1:210 MOUNTAIN BLVD.
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069
Practice Address - Country:US
Practice Address - Phone:908-754-2200
Practice Address - Fax:908-754-0140
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI16160122300000X
NJDI016160001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist