Provider Demographics
NPI:1295912863
Name:TADDEO, RICHARD GREGORY (DMD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:GREGORY
Last Name:TADDEO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 NORTHFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-4723
Mailing Address - Country:US
Mailing Address - Phone:973-731-5878
Mailing Address - Fax:973-731-5052
Practice Address - Street 1:149 NORTHFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4723
Practice Address - Country:US
Practice Address - Phone:973-731-5878
Practice Address - Fax:973-731-5052
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-26
Last Update Date:2008-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ090291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice