Provider Demographics
NPI:1295753507
Name:ZAMBITO, RICARDO DEAN (DDS)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:DEAN
Last Name:ZAMBITO
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 1:1201 MT DE CHANTAL RD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6332
Mailing Address - Country:US
Mailing Address - Phone:304-243-1500
Mailing Address - Fax:304-243-0249
Practice Address - Street 1:1201 MOUNT DE CHANTAL RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6332
Practice Address - Country:US
Practice Address - Phone:304-243-1500
Practice Address - Fax:304-243-0249
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0136714000Medicaid