Provider Demographics
NPI:1437243318
Name:CICCARELLI, RICHARD A (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:CICCARELLI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 PITTSBURGH ST
Mailing Address - Street 2:
Mailing Address - City:CHESWICK
Mailing Address - State:PA
Mailing Address - Zip Code:15024-1525
Mailing Address - Country:US
Mailing Address - Phone:724-274-8185
Mailing Address - Fax:724-274-4287
Practice Address - Street 1:1705 PITTSBURGH ST
Practice Address - Street 2:
Practice Address - City:CHESWICK
Practice Address - State:PA
Practice Address - Zip Code:15024-1525
Practice Address - Country:US
Practice Address - Phone:724-274-8185
Practice Address - Fax:724-274-4287
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018661L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry