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General NPI Number Information
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NPI Number | 1689102030
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Entity Type | Individual
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Provider Name | JENNALEE DICICCO DMD
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Gender | Female
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Dates
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Enumeration Date | 05/30/2017
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 1500 JFK BLVD STE 300
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City | PHILADELPHIA
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State | PA
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Zip | 19102-1733
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Country | US
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Telephone | 267-514-8100
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Fax | 215-701-1108
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Provider Business Mailing Address
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Address Line | 30 PROSPECT AVE
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City | HACKENSACK
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State | NJ
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Zip | 07601-1915
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Country | US
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Telephone | 551-996-2000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS042226
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License Number State | PA
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