MEDICARE: DR. JOSEPH RICHARD ZICCHINO DDS

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	122300000X	Dentist	D120087	NJ

General Provider Information

NPI Number	:	1437269271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH RICHARD ZICCHINO DDS

Provider Business Mailing Address
First Line	:	2407 BRIDGE AVE
Second Line	:
City	:	POINT PLEASANT BORO
State	:	NJ
Zip	:	08742-4334
Country	:	US
Telephone Number	:	732-714-1030
Fax Number	:

Provider Business Practice Location Address
First Line	:	2407 BRIDGE AVE
Second Line	:
City	:	POINT PLEASANT BORO
State	:	NJ
Zip	:	08742-4334
Country	:	US
Telephone Number	:	732-714-1030
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/16/2007

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