Provider Demographics
NPI:1619058831
Name:CIROCCO DENTAL CENTER PC
Entity Type:Organization
Organization Name:CIROCCO DENTAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:CIROCCO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-282-1278
Mailing Address - Street 1:5280 ROUTE 309
Mailing Address - Street 2:
Mailing Address - City:CENTER VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18034-8219
Mailing Address - Country:US
Mailing Address - Phone:610-282-1278
Mailing Address - Fax:484-863-4933
Practice Address - Street 1:5280 ROUTE 309
Practice Address - Street 2:
Practice Address - City:CENTER VALLEY
Practice Address - State:PA
Practice Address - Zip Code:18034-1803
Practice Address - Country:US
Practice Address - Phone:610-282-1278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X
PADS031336L261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No122300000XDental ProvidersDentistGroup - Single Specialty