Provider Demographics
NPI:1669483921
Name:CICCHETTI, NICOLA W (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLA
Middle Name:W
Last Name:CICCHETTI
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 1:18 E WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07204-2208
Mailing Address - Country:US
Mailing Address - Phone:908-245-9463
Mailing Address - Fax:908-245-0969
Practice Address - Street 1:18 E WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:ROSELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07204-2208
Practice Address - Country:US
Practice Address - Phone:908-245-9463
Practice Address - Fax:908-245-0969
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD176111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice