MEDICARE: DR. JOHN PAUL ICKOWICZ D.D.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	1223G0001X	General Practice Dentistry	052110	NY

General Provider Information

NPI Number	:	1548432362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN PAUL ICKOWICZ D.D.S.

Provider Business Mailing Address
First Line	:	1450 BELLMORE AVE
Second Line	:
City	:	NORTH BELLMORE
State	:	NY
Zip	:	11710-5540
Country	:	US
Telephone Number	:	516-785-2064
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 BELLMORE AVE
Second Line	:
City	:	NORTH BELLMORE
State	:	NY
Zip	:	11710-5540
Country	:	US
Telephone Number	:	516-785-2064
Fax Number	:	516-785-9413

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

Provider Enumeration Date	:	04/01/2008
Last Update Date	:	01/31/2014

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