Healthcare Provider Details

I. General information

NPI: 1013953850
Provider Name (Legal Business Name): RICHARD H CIPOLARO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 HOLLAND AVE
ALBANY NY
12208-3410
US

IV. Provider business mailing address

18 GRANT HILL RD
CLIFTON PARK NY
12065-7630
US

V. Phone/Fax

Practice location:
  • Phone: 518-626-6572
  • Fax:
Mailing address:
  • Phone: 518-371-0061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number030820
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: