Individual
DR. MICHAEL A RENALDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1521 8TH AVE STE 101, BETHLEHEM, PA 18018-1893
(610) 865-8077
(610) 865-8112
Mailing address
1521 8TH AVE STE 101, BETHLEHEM, PA 18018-1893
(610) 865-8077
(610) 865-8112
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS019414L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01412301
CAPITAL BLUE CROSS
PA
01
—
028552
PA BLUE SHIELD
PA
01
—
182033
US HEALTHCARE
PA
01
—
232702929
FEDERAL TAX ID #
PA
01
—
DS019414L
DENTAL LICENSE NUMBER
PA
Enumeration date
08/24/2005
Last updated
05/22/2014
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