Basic Information
| Provider Information | |||||||||
| NPI: | 1669483921 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CICCHETTI | ||||||||
| FirstName: | NICOLA | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18 E WESTFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | ROSELLE PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 072042208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082459463 | ||||||||
| FaxNumber: | 9082450969 | ||||||||
| Practice Location | |||||||||
| Address1: | 18 E WESTFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | ROSELLE PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 072042208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082459463 | ||||||||
| FaxNumber: | 9082450969 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | D17611 | NJ | Y | Dental Providers | Dentist | General Practice |
No ID Information.