Provider Demographics
NPI:1952503732
Name:LORACONO, JOSEPH R JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:R
Last Name:LORACONO
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 1:764 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PECKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18452-2342
Mailing Address - Country:US
Mailing Address - Phone:570-383-2411
Mailing Address - Fax:570-383-6954
Practice Address - Street 1:764 MAIN STREET
Practice Address - Street 2:
Practice Address - City:PECKVILLE
Practice Address - State:PA
Practice Address - Zip Code:18452-2342
Practice Address - Country:US
Practice Address - Phone:570-383-2411
Practice Address - Fax:570-383-6954
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017163L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist