Healthcare Provider Details

I. General information

NPI: 1437243318
Provider Name (Legal Business Name): RICHARD A. CICCARELLI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 PITTSBURGH ST
CHESWICK PA
15024-1525
US

IV. Provider business mailing address

1705 PITTSBURGH ST
CHESWICK PA
15024-1525
US

V. Phone/Fax

Practice location:
  • Phone: 724-274-8185
  • Fax: 724-274-4287
Mailing address:
  • Phone: 724-274-8185
  • Fax: 724-274-4287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS018661L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: