Provider Demographics
NPI:1841596749
Name:PAUL A RICCHETTI JR DDS MSCD INC
Entity Type:Organization
Organization Name:PAUL A RICCHETTI JR DDS MSCD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:RICCHETTI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-461-6008
Mailing Address - Street 1:5825 LANDERBROOK DR
Mailing Address - Street 2:SUITE 221
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-6532
Mailing Address - Country:US
Mailing Address - Phone:440-461-6008
Mailing Address - Fax:440-461-9282
Practice Address - Street 1:5825 LANDERBROOK DR
Practice Address - Street 2:SUITE 221
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-6532
Practice Address - Country:US
Practice Address - Phone:440-461-6008
Practice Address - Fax:440-461-9282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH141431223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT47409Medicare UPIN
OHRI0504512Medicare PIN