Healthcare Provider Details

I. General information

NPI: 1174746101
Provider Name (Legal Business Name): RALPH TARANTINO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 GRANDVIEW AVE
STATEN ISLAND NY
10303-1833
US

IV. Provider business mailing address

441 GRANDVIEW AVE
STATEN ISLAND NY
10303
US

V. Phone/Fax

Practice location:
  • Phone: 718-494-0037
  • Fax: 718-494-0881
Mailing address:
  • Phone: 718-494-0037
  • Fax: 718-494-0881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD045050
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: