MEDICARE: DR. RONALDO CONCINA DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	19919	NJ

General Provider Information

NPI Number	:	1427263714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALDO CONCINA DMD

Provider Business Mailing Address
First Line	:	456 BARTLETT ST
Second Line	:
City	:	ROSELLE
State	:	NJ
Zip	:	07203-1847
Country	:	US
Telephone Number	:	908-241-6653
Fax Number	:

Provider Business Practice Location Address
First Line	:	345 SOMERSET ST
Second Line	:
City	:	NORTH PLAINFIELD
State	:	NJ
Zip	:	07060-4774
Country	:	US
Telephone Number	:	908-561-7068
Fax Number	:	908-561-0356

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	07/08/2007

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