Provider Demographics
NPI:1205458692
Name:RACANELLI, JOSEPH VITO (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:VITO
Last Name:RACANELLI
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 1:109 UPPER LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-2831
Mailing Address - Country:US
Mailing Address - Phone:845-325-7760
Mailing Address - Fax:
Practice Address - Street 1:153 STEVENS AVE STE 1
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2543
Practice Address - Country:US
Practice Address - Phone:914-650-2336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061820-011223G0001X
NJ22D102454001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice