Provider Demographics
NPI:1376638387
Name:LOCICERO, JAMES C (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:C
Last Name:LOCICERO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:60 ORLAND SQUARE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-6548
Mailing Address - Country:US
Mailing Address - Phone:708-403-5757
Mailing Address - Fax:708-403-5768
Practice Address - Street 1:60 ORLAND SQUARE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-6548
Practice Address - Country:US
Practice Address - Phone:708-403-5757
Practice Address - Fax:708-403-5768
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-171381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice