Healthcare Provider Details

I. General information

NPI: 1487195418
Provider Name (Legal Business Name): CICERO FAMILY DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8382 ELTA DR
CICERO NY
13039-8905
US

IV. Provider business mailing address

8382 ELTA DR
CICERO NY
13039-8905
US

V. Phone/Fax

Practice location:
  • Phone: 315-699-3305
  • Fax: 315-699-0500
Mailing address:
  • Phone: 315-699-3305
  • Fax: 315-699-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number044294-1
License Number StateNY

VIII. Authorized Official

Name: DR. SHAFEY SAYED
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 315-699-3305