Provider Demographics
NPI:1518014984
Name:CICINATO, STEPHEN PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:PAUL
Last Name:CICINATO
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 1:109 EXETER ST
Mailing Address - Street 2:
Mailing Address - City:MANTEO
Mailing Address - State:NC
Mailing Address - Zip Code:27954-9400
Mailing Address - Country:US
Mailing Address - Phone:252-475-5071
Mailing Address - Fax:252-473-2153
Practice Address - Street 1:109 EXETER ST
Practice Address - Street 2:
Practice Address - City:MANTEO
Practice Address - State:NC
Practice Address - Zip Code:27954-9400
Practice Address - Country:US
Practice Address - Phone:252-475-5071
Practice Address - Fax:252-473-2153
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA54461223G0001X
NC6425122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice