Healthcare Provider Details

I. General information

NPI: 1083880710
Provider Name (Legal Business Name): CICHETTI & DELLIGATTI ORTHODONTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 JAYMOR RD SUITE 130A
SOUTHAMPTON PA
18966-3826
US

IV. Provider business mailing address

6404 ROOSEVELT BLVD
PHILADELPHIA PA
19149-2943
US

V. Phone/Fax

Practice location:
  • Phone: 215-942-7300
  • Fax: 215-942-7386
Mailing address:
  • Phone: 215-743-3700
  • Fax: 215-743-3706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS020222L
License Number StatePA

VIII. Authorized Official

Name: MRS. SUSAN FOX
Title or Position: INSURANCE MANAGER
Credential:
Phone: 215-743-3700