MEDICARE: DR. RICHARD A. CICCARELLI DMD

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	1223P0221X	Pediatric Dentistry	DS018661L	PA

General Provider Information

NPI Number	:	1437243318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD A. CICCARELLI DMD

Provider Business Mailing Address
First Line	:	1705 PITTSBURGH ST
Second Line	:
City	:	CHESWICK
State	:	PA
Zip	:	15024-1525
Country	:	US
Telephone Number	:	724-274-8185
Fax Number	:	724-274-4287

Provider Business Practice Location Address
First Line	:	1705 PITTSBURGH ST
Second Line	:
City	:	CHESWICK
State	:	PA
Zip	:	15024-1525
Country	:	US
Telephone Number	:	724-274-8185
Fax Number	:	724-274-4287

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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