Provider Demographics
NPI:1295705150
Name:PICCIONE, MICHAEL JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:PICCIONE
Suffix:
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 1:111 MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324
Mailing Address - Country:US
Mailing Address - Phone:912-677-0006
Mailing Address - Fax:888-289-4301
Practice Address - Street 1:111 MARKET STREET
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324
Practice Address - Country:US
Practice Address - Phone:912-677-0006
Practice Address - Fax:888-289-4301
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0501211223G0001X
GADN0145161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP9424223OtherFEDERAL DEA
GAFP1729788OtherDEA NUMBER