Provider Demographics
NPI:1487195418
Name:CICERO FAMILY DENTAL CARE
Entity Type:Organization
Organization Name:CICERO FAMILY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAFEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAYED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-699-3305
Mailing Address - Street 1:8382 ELTA DR
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-8905
Mailing Address - Country:US
Mailing Address - Phone:315-699-3305
Mailing Address - Fax:315-699-0500
Practice Address - Street 1:8382 ELTA DR
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-8905
Practice Address - Country:US
Practice Address - Phone:315-699-3305
Practice Address - Fax:315-699-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044294-1261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental