Healthcare Provider Details

I. General information

NPI: 1639457625
Provider Name (Legal Business Name): JOSEPH ANTHONY CICCIO JR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PONDFIELD RD SUITE 304
BRONXVILLE NY
10708-3706
US

IV. Provider business mailing address

1 PONDFIELD RD SUITE 304
BRONXVILLE NY
10708-3706
US

V. Phone/Fax

Practice location:
  • Phone: 914-337-4700
  • Fax:
Mailing address:
  • Phone: 914-337-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number037624
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: