Provider Demographics
NPI:1871841924
Name:PICCOLO, CLAUDIA PATRICIA (DDS)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:PATRICIA
Last Name:PICCOLO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6898
Mailing Address - Country:US
Mailing Address - Phone:773-528-0068
Mailing Address - Fax:773-528-0088
Practice Address - Street 1:1426 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6898
Practice Address - Country:US
Practice Address - Phone:773-528-0068
Practice Address - Fax:773-528-0088
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0291591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice