Provider Demographics
NPI:1114070075
Name:SICURELLI, ROBERT JAMES JR (ABDDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAMES
Last Name:SICURELLI
Suffix:JR
Gender:M
Credentials:ABDDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 WICKAPOGUE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-3014
Mailing Address - Country:US
Mailing Address - Phone:631-287-4300
Mailing Address - Fax:631-287-9820
Practice Address - Street 1:157 WICKAPOGUE RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-3014
Practice Address - Country:US
Practice Address - Phone:631-287-4300
Practice Address - Fax:631-287-9820
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0393301223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics