Healthcare Provider Details

I. General information

NPI: 1437289485
Provider Name (Legal Business Name): JOHN RICHARD CICHON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3996 WALDEN AVE
LANCASTER NY
14086-1410
US

IV. Provider business mailing address

3996 WALDEN AVE
LANCASTER NY
14086-1410
US

V. Phone/Fax

Practice location:
  • Phone: 716-683-2001
  • Fax: 716-683-2009
Mailing address:
  • Phone: 716-683-2001
  • Fax: 716-683-2009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number041376
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: