Provider Demographics
NPI:1548516198
Name:LADINO, JOSE LUIS (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LUIS
Last Name:LADINO
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 1:679 48TH ST
Mailing Address - Street 2:APT 4K
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-2153
Mailing Address - Country:US
Mailing Address - Phone:917-499-3449
Mailing Address - Fax:
Practice Address - Street 1:3553 82ND ST
Practice Address - Street 2:SUITE 1E
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-5162
Practice Address - Country:US
Practice Address - Phone:718-476-4176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0562061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03486519Medicaid