John David Ridella, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

026351 Issued in PA

Practice address

901 Menoher Blvd
Johnstown, PA 15905

Phone

(814) 536-5646

Fax

(814) 536-1774

NPI assigned

Sep 20, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215035084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 MENOHER BLVD",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "15905",
            "telephone_number": "814-536-5646",
            "fax_number": "814-536-1774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 MENOHER BLVD",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "15905",
            "telephone_number": "814-536-5646",
            "fax_number": "814-536-1774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDELLA",
        "first_name": "JOHN",
        "middle_name": "DAVID",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "026351",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "BR1727215",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Peter James Ridella, MD
• Adele Marie Rieger-McCombie, PHARMD
• Brian Riek
• Gary F Risko, PAC
• Rite Aid of Pennsylvania LLC

• Dentist in Johnstown, PA
• Providers in Johnstown, PA by specialty
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.