Provider Demographics
NPI:1821335373
Name:NUCCI, ERSIO LAWRENCE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERSIO
Middle Name:LAWRENCE
Last Name:NUCCI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:E.
Other - Middle Name:LAWRENCE
Other - Last Name:NUCCI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:4212 OLD WILLIAM PENN HWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-1901
Mailing Address - Country:US
Mailing Address - Phone:724-327-7778
Mailing Address - Fax:724-327-4497
Practice Address - Street 1:4212 OLD WILLIAM PENN HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-1901
Practice Address - Country:US
Practice Address - Phone:724-327-7778
Practice Address - Fax:724-327-4497
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018578L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist