Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 046051 | NY |
NPI | 1073721262 |
---|---|
Provider Name | Dr. Ralph V Daniello |
First Address | Ballston Spa, NY 12020-1367 |
Second Address | Ballston Spa, NY 12020-1367 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2007 |
Last Update Date | 08/07/2007 |