Healthcare Provider Details

I. General information

NPI: 1033135884
Provider Name (Legal Business Name): LENNIE M CHECCHIO D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9525 FRANKFORD AVE
PHILADELPHIA PA
19114-2812
US

IV. Provider business mailing address

9525 FRANKFORD AVE
PHILADELPHIA PA
19114-2812
US

V. Phone/Fax

Practice location:
  • Phone: 215-333-9697
  • Fax: 215-333-8514
Mailing address:
  • Phone: 215-333-9697
  • Fax: 215-333-8514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS021854L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: