Basic Information
Provider Information
NPI: 1003010083
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CANALICHIO
FirstName: JAMES
MiddleName: JOSEPH
NamePrefix: DR.
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7512 MAPLE AVENUE
Address2:  
City: PENNSAUKEN
State: NJ
PostalCode: 08109
CountryCode: US
TelephoneNumber: 8566655101
FaxNumber:  
Practice Location
Address1: 7512 MAPLE AVENUE
Address2:  
City: PENNSAUKEN
State: NJ
PostalCode: 081093327
CountryCode: US
TelephoneNumber: 8566655101
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/13/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X22DI00950700NJY Dental ProvidersDentistGeneral Practice

No ID Information.


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