Healthcare Provider Details

I. General information

NPI: 1578566550
Provider Name (Legal Business Name): JOSEPH ALAN CIONI D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 W SAINT LOUIS ST STE 1
LEBANON IL
62254-1515
US

IV. Provider business mailing address

318 W SAINT LOUIS ST
LEBANON IL
62254-1561
US

V. Phone/Fax

Practice location:
  • Phone: 618-537-2017
  • Fax: 618-537-9510
Mailing address:
  • Phone: 618-537-6341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: