MEDICARE: DR. PASQUALINO DICICCIO D.D.S., M.S.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DS33920	CA

General Provider Information

NPI Number	:	1205057056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PASQUALINO DICICCIO D.D.S., M.S.

Provider Business Mailing Address
First Line	:	7104 N. FRESNO STREET
Second Line	:	SUITE 102
City	:	FRESNO
State	:	CA
Zip	:	93720
Country	:	US
Telephone Number	:	559-225-2251
Fax Number	:	559-490-2254

Provider Business Practice Location Address
First Line	:	7104 N. FRESNO STREET
Second Line	:	SUITE 102
City	:	FRESNO
State	:	CA
Zip	:	93720
Country	:	US
Telephone Number	:	559-225-2251
Fax Number	:	559-490-2254

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/08/2007

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