Provider Demographics
NPI:1972756211
Name:GIRALDO, JHON ONEILL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JHON
Middle Name:ONEILL
Last Name:GIRALDO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 SHREWSBURY ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-4648
Mailing Address - Country:US
Mailing Address - Phone:508-799-0002
Mailing Address - Fax:
Practice Address - Street 1:225 SHREWSBURY ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-4648
Practice Address - Country:US
Practice Address - Phone:508-799-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855972122300000X
NH03921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist