Provider Demographics
NPI:1790945392
Name:PICCIONE, JOHN ROBERT JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:PICCIONE
Suffix:JR
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 1:1322 E WASHINGTON ST
Mailing Address - Street 2:STE D1
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-1866
Mailing Address - Country:US
Mailing Address - Phone:864-235-1200
Mailing Address - Fax:864-235-2512
Practice Address - Street 1:1322 E WASHINGTON ST
Practice Address - Street 2:STE D1
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-1866
Practice Address - Country:US
Practice Address - Phone:864-235-1200
Practice Address - Fax:864-235-2512
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice