Provider Demographics
NPI:1265651244
Name:CICCONE, ROBERT JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:CICCONE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5830 HARRISON RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-4202
Mailing Address - Country:US
Mailing Address - Phone:540-710-0400
Mailing Address - Fax:540-710-2322
Practice Address - Street 1:5830 HARRISON RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-4202
Practice Address - Country:US
Practice Address - Phone:540-710-0400
Practice Address - Fax:540-710-2322
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006727122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist