MEDICARE: ROBERT T. PICCOLI DDS, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	8094	NJ

General Provider Information

NPI Number	:	1144340837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT T. PICCOLI DDS, PA

Provider Business Mailing Address
First Line	:	710 HIGH MOUNTAIN RD
Second Line	:
City	:	FRANKLIN LAKES
State	:	NJ
Zip	:	07417-2911
Country	:	US
Telephone Number	:	201-891-5352
Fax Number	:	201-891-5349

Provider Business Practice Location Address
First Line	:	710 HIGH MOUNTAIN RD
Second Line	:
City	:	FRANKLIN LAKES
State	:	NJ
Zip	:	07417-2911
Country	:	US
Telephone Number	:	201-891-5352
Fax Number	:	201-891-5349

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT THOMAS PICCOLI
Credential	:	DDS
Telephone Number	:	201-891-5352

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	08/22/2020

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