Provider Demographics
NPI:1023239969
Name:RONGO, RICHARD R (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:R
Last Name:RONGO
Suffix:
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 1:50 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3533
Mailing Address - Country:US
Mailing Address - Phone:631-470-5775
Mailing Address - Fax:
Practice Address - Street 1:50 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3533
Practice Address - Country:US
Practice Address - Phone:631-470-5775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0416711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice