Provider Demographics
NPI:1265652416
Name:ILACQUA, CLELIA C (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLELIA
Middle Name:C
Last Name:ILACQUA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 COLD HILL RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MENDHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07945
Mailing Address - Country:US
Mailing Address - Phone:973-543-5700
Mailing Address - Fax:973-543-5722
Practice Address - Street 1:5 COLD HILL RD
Practice Address - Street 2:SUITE 7
Practice Address - City:MENDHAM
Practice Address - State:NJ
Practice Address - Zip Code:07945
Practice Address - Country:US
Practice Address - Phone:973-543-5700
Practice Address - Fax:973-543-5722
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ12248122300000X
NY33899122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist