Provider Demographics
NPI:1245903905
Name:DI GIANFILIPPO, RICCARDO (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:RICCARDO
Middle Name:
Last Name:DI GIANFILIPPO
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42301 CHERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-9801
Mailing Address - Country:US
Mailing Address - Phone:734-981-7477
Mailing Address - Fax:
Practice Address - Street 1:42301 CHERRY HILL RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-9801
Practice Address - Country:US
Practice Address - Phone:734-981-7477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601082APP211223P0300X
MI29016010821223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics