Provider Demographics
NPI:1427263714
Name:CONCINA, RONALDO (DMD)
Entity type:Individual
Prefix:DR
First Name:RONALDO
Middle Name:
Last Name:CONCINA
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 1:456 BARTLETT ST
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-1847
Mailing Address - Country:US
Mailing Address - Phone:908-241-6653
Mailing Address - Fax:
Practice Address - Street 1:345 SOMERSET ST
Practice Address - Street 2:
Practice Address - City:NORTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-4774
Practice Address - Country:US
Practice Address - Phone:908-561-7068
Practice Address - Fax:908-561-0356
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ19919122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist