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General NPI Number Information
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NPI Number | 1982121778
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Entity Type | Organization
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Legal Business Name | MADISON DENTISTRY, P.C.
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Dates
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Enumeration Date | 08/23/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 424 MADISON AVE FL 15
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City | NEW YORK
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State | NY
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Zip | 10017-1158
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Country | US
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Telephone | 212-753-7400
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Fax |
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Provider Business Mailing Address
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Address Line | 424 MADISON AVE FL 15
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City | NEW YORK
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State | NY
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Zip | 10017-1158
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Country | US
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Telephone | 212-753-7400
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FRANK DICICCO
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Credential | DMD
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Telephone | 212-753-7400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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