Healthcare Provider Details

I. General information

NPI: 1801307319
Provider Name (Legal Business Name): GIUSEPPE CICERO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 GRANITE ST
WESTERLY RI
02891-2495
US

IV. Provider business mailing address

130 GRANITE ST
WESTERLY RI
02891-2495
US

V. Phone/Fax

Practice location:
  • Phone: 401-596-2848
  • Fax:
Mailing address:
  • Phone: 401-596-2848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDEN03359
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: