Provider Demographics
NPI:1851592042
Name:OPEN WIDE DENTAL, PC
Entity Type:Organization
Organization Name:OPEN WIDE DENTAL, PC
Other - Org Name:THOMAS W. RIUTTA, JR, DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:RIUTTA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-751-0065
Mailing Address - Street 1:17 QUAKER PATH
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-1307
Mailing Address - Country:US
Mailing Address - Phone:631-751-0065
Mailing Address - Fax:631-751-0103
Practice Address - Street 1:17 QUAKER PATH
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-1307
Practice Address - Country:US
Practice Address - Phone:631-751-0065
Practice Address - Fax:631-751-0103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0466991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty