Healthcare Provider Details

I. General information

NPI: 1124539663
Provider Name (Legal Business Name): JOHN CIPOLLINA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DR. JOHN CIPOLLINA

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

687 YONKERS AVE
YONKERS NY
10704-2673
US

IV. Provider business mailing address

687 YONKERS AVE
YONKERS NY
10704-2673
US

V. Phone/Fax

Practice location:
  • Phone: 914-969-0303
  • Fax: 914-969-3003
Mailing address:
  • Phone: 914-969-0303
  • Fax: 914-969-3003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number034484
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: