Provider Demographics
NPI:1437289485
Name:CICHON, JOHN RICHARD (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RICHARD
Last Name:CICHON
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 1:3996 WALDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-1410
Mailing Address - Country:US
Mailing Address - Phone:716-683-2001
Mailing Address - Fax:716-683-2009
Practice Address - Street 1:3996 WALDEN AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14086-1410
Practice Address - Country:US
Practice Address - Phone:716-683-2001
Practice Address - Fax:716-683-2009
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0413761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice