Provider Demographics
NPI:1881795094
Name:RINAUDO, JOHN M (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:RINAUDO
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 1:22 HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-3114
Mailing Address - Country:US
Mailing Address - Phone:718-667-5498
Mailing Address - Fax:718-667-0031
Practice Address - Street 1:3975 SEDGWICK AVE
Practice Address - Street 2:SUITE 1-H
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3105
Practice Address - Country:US
Practice Address - Phone:718-796-4600
Practice Address - Fax:718-667-0031
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043733-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice